Custom constraints


Introduction


In this module you will learn more about how and when to create custom constraints based on path navigation. This module assumes you have basic knowledge on profiling. If you prefer to start with the basics, please go through the Introduction to FHIR and profiling or Start profiling module first. In the exercise of this module we will use Forge, the official HL7® FHIR® profile editor. You can download Forge for free.

The topics covered in this module are:

  • Path navigation: what do we mean by it, how do we use it and when do we need it?
  • The basics of FHIRPath, a path navigation language designed for FHIR
  • When and how to use invariants in your profiles
  • How to add element paths in search parameters

Reading material


1. Path navigation

A FHIR resource contains a hierarchical list of properties, called elements. There are many cases in which one needs to refer to a particular element in the hierarchy. For example when you want to define the path of a discriminator, the path to a specific element in a search parameter or rules on elements in your profile.

In FHIR, two path expression languages are used to navigate through resources and their elements. The first one is XPath, a XML path language to select nodes in a XML document. The adoption of this language is low, however, the main reasons being that it is XML specific and not well adopted. The second one is FHIRPath, a path based navigation and extraction language, that is similar to XPath, but designed specifically for FHIR. Operations are expressed in terms of the logical content of hierarchical data models, and support traversal, selection, and filtering of data.

In this module we will focus mainly on FHIRPath and its use in profiling. We will start with a brief introduction into FHIRPath. In the next chapters you will learn how to create rules on elements called invariants and how to define element paths in search parameters.

2. FHIRPath

FHIRPath allows you to navigate through the element tree of a resource. For example, you can use the expression name.given to retrieve all values of the given element. Note that this expression will navigate through all name elements and result in a collection of all given elements present in each name element. It is not necessary to provide the root node in the expression (e.g. Patient.name.given). Both expressions will have the same outcome for Patient resources, but the latter will only return results when evaluated on resources of type Patient.

2.1 Output of a FHIRPath expression (collections)

Keep in mind that the result of a FHIRPath expression is always a collection, even if the returned value is a single item. This collection is ordered, non-unique, indexed and countable. These characteristics are explained below.

Type Description
Ordered The order of items is maintained as much as possible.
Non-unique The collection may contain duplicate items. Although allowed, there are functions available to remove duplicates from the collection.
Indexed The items in the collections are indexed starting by 0 for the first item, 1 for the second and so on.
Countable It is possible to count the number of items in a collection using the function count().

Note in FHIRPath there is no such a thing as a null value, instead if there's no data available this will result in an empty collection (represented as {}).

2.2 Symbols and operators

2.2.1 Symbols

The following symbols are allowed in a FHIRPath expression.

Symbol Description Example
() Parentheses for delimiting groups within expressions (name.given | name.family)
[] Brackets for indexing into lists and strings name[0]
{} Braces for delimiting lists {value1, value2}
. Period for qualifiers, accessors, and dot-invocation name.given
, Comma for delimiting items in a syntactic list {value1, value2}
= != ~ !~ < > <= >= Comparison operators for comparing values name = "Chalmers"
+ - * / Mathematical operators 1+3
& String concatenation name.given & " " & name.family
2.2.2 Logical operators

Below is a list of all basic logical operators that are supported in a FHIRPath expression.

Operator Evaluation Example
and Returns true if both operands evaluate to true, false if one of the operands evaluates to false and an empty collection in all other cases a and b
or Returns false if both operands evaluate to false, true if one or both of the operands evaluate to true and an empty collection in all other cases a or b
xor Returns true if one of the operands evaluates to true, false if one both operands evaluate to true or both operands evaluate to false and an empty collection in all other cases a xor b
implies The right operand of this operator will only be evaluated when the left operand evaluates to false. Returns true when the left operand evaluates to false and an empty collection when the left operand is empty. When the left operand is false, the right operand will be evaluated. In this case the value of the right operand (either true, false or empty) will be returned. a implies b
2.2.3 Data type operators

As explained earlier, the root type is optional in a FHIRPath expression. In the same way you can either ignore the type of an element in your expression (resulting in a collection containing items of one or more data types) or filter the collection on type before navigating further down the tree (i.e. by using the ofType element). The following data type operators can be used to determine if an item is of a specific type or to treat an item as a specific type.

Operator Evaluation Example
is Returns true if a single item in a collection is of a given data type and false if it isn't. Returns an error if the collection contains more than one item. In all other cases an empty collection is returned. name.given is "Peter"
as Treats an item as a specific type. Returns a single item in a collection if it is of the specified type and an empty collection otherwise. Returns an error when the collection contains more than one item or when a single item cannot be resolved to a valid type. Observation.value as Quantity
2.2.4 Collection operators
Operator Evaluation Example
| Merges two collections into one single collection. When one of the collections is empty, the non-empty collection will be returned. Duplicate items are removed. name.given|name.family
in Returns true if the left operand includes a single item that is also present in the right operand collection. Returns an empty collection if the left operand is empty. Returns an error if the left operand includes more than one item. "Peter" in name.given
contains This is the inverse operation of in, returning true if the left operand includes a single item present in the right operand. name.given contains {"Peter","James"}

2.3 FHIRPath invocations

FHIRPath expressions may contain literals and/or function invocations.

2.3.1 Literals

The following literals are supported:

literal values
boolean true, false
string 'test string', 'urn:oid:3.4.5.6.7.8'
integer 0, 45
decimal 0.0, 3.141592653589793236
dateTime @2015-02-04T14:34:28Z (@ followed by ISO8601 compliant date/time)
time @T14:34:28+09:00 (@ followed by ISO8601 compliant time beginning with T)
quantity 10 'mg', 4 days

2.3.2 Functions

For a complete list of functions, visit the FHIRPath specification. Below is a list of examples of functions that are often used in FHIRPath expressions.

Function Returns Description
empty() Boolean Returns true if the collection is empty and false if it's not
not() Boolean Returns true if the collection evaluates to false and false if it evaluates to true. Returns an empty collection in all other cases
exists([expression]) Boolean Returns false if the collection is empty and true if it's not. Optional criteria can be applied before evaluation, which would be equivalent to (criteria).exists()
first() Collection Returns the first item in a collection if non-empty and an empty collection otherwise. This function is equivalent to item(0).
last() Collection Returns the last item in a collection if non-empty and an empty collection otherwise.
where(expression) Collection Returns the collection filtered based on the given criteria. Items that evaluate to true are included, while items that evaluate to false or empty are excluded.
iif(expression, true-result, [otherwise-result]) Collection Returns the value of the true-result if the criterium is true and the value of the (optional) otherwise-result when the criterium is false or the collection is empty. If there's not otherwise-result, an empty collection is returned instead.
contains(string) Boolean Returns true if the given string is a substring of a single string item in a collection or when substring is an empty string.
combine(collection) Collections Combines the collection with the given collection without removing any duplicates.

3. Invariants

Invariants can be used to place additional constraints on elements based on XPath or FHIRPath expressions.

For example, say you want to make it mandatory to add a reason when a medication is not administered. You can't do so by changing the minimum cardinality of the reasonNotGiven element to 1, because the element is only mandatory when specific criteria are met. In this case, you could use the following expression:

notGiven implies reasonNotGiven.exists()

The first part of this expression is the boolean value of the notGiven element. The second part of the expression will only be evaluated when the value of this element is true. When the value of the notGiven element is false, the second part of the expression will not be evaluated and the entire expression will evaluate to true. When the notGiven element is empty, the expression will return an empty collection.

The second part of the expression returns true when the reasonNotGiven element has a value and false otherwise. So the meaning of this expression is that when the value of the notGiven element is true, the reasonNotGiven element should exist.

3.1 Adding a constraint to an ElementDefinition

The ElementDefinition has a child element called constraint that can be used to add expressions.

It is mandatory to provide a key, a severity (error or warning), a human description of the constraint and the actual FHIRPath expression. The corresponding XPath expression is optional.

Below is an example of what the XML code would look like when adding a constraint on the reasonNotGiven element as explained above.

<element id="MedicationAdministration.reasonNotGiven">
<path value="MedicationAdministration.reasonNotGiven"/>
<constraint>
<key value="ele-2"/>
<severity value="error"/>
<human value="If medication is not given the reason should be present"/>
<expression value="notGiven implies reasonNotGiven.exists()"/>
</constraint>
</element>

3.2 Adding constraints in Forge

When you want to add a constraint to an element using Forge, navigate down the element properties and click + next to Constraints. Add a Key and select a Severity (warning or error). In the Expression field add your FHIRPath expression. In the Description field add a human-readable description of your expression.

4. Element paths in search parameters

In a SearchParameter resource it is necessary to define the path to the element that is used to evaluate the search parameter against. You may either use the expression element to define a FHIRPath expression or the xpath element to define a XPath expression. Note that the xpathUsage element is required when the xpath element is used to indicate how the xpath statement should be interpreted.

Below is an example of a search parameter that can be used to filter on the clinical status of a Condition.

<SearchParameter xmlns="http://hl7.org/fhir">
  <id value="clinicalstatus" />
  <url value="http://hl7.org/fhir/SearchParameter/Condition-clinicalstatus" />
  <name value="clinicalstatus" />
  <status value="active" />
  <code value="clinicalstatus" />
  <base value="Condition" />
  <type value="token" />
  <description value="The clinical status of the condition" />
  <expression value="Condition.clinicalStatus" />
  <xpath value="f:Condition/f:clinicalStatus" />
  <xpathUsage value="normal" />
</SearchParameter>

Note that search parameters can be made more generic by leaving out the root type in the expression and selecting multiple resource types in the base value. When you want to apply your search parameter to all resource types, use Resource as the base value and the root type.

<base value="Resource" />
<type value="token" />
<description value="Logical id of this artifact" />
  <expression value="Resource.id" />
  <xpath value="f:Resource/f:id" />
  <xpathUsage value="normal" />
</SearchParameter>

Real-life examples


Data Access Framework (DAF)

The HL7 US Data Access Framework (DAF) Initiative aims to identify, test and validate standards required to access and extract data from internal and external health IT systems at a (inter)national level. DAF aims to provide standards that help users to access data across multiple systems and/or organizations.

Below are the details of the DAF-Pract profile on Practitioner. This profile has an invariant constraining the name and identifier elements in such a way that at least one one of them is mandatory. In other words, a Practitioner should have either a name, an identifier or both - see inv-1:

Practitioner(DAF-Pract)
Definition

This is basic constraint on provider for use in DAF resources.

Control0..*
TypePractitioner
Alternate NamesProvider
Comments

Note that a cab driver no longer fits the bill. You probably would be interested in the organization rather than the individual?

InvariantsDefined on this element
inv-1: Shall havePractitioner.name and/or Practitioner.identifier. (xpath: exists(f:name) or exists(f:identifier))
Practitioner.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

Practitioner.meta
Definition

The 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.

Control0..1
TypeMeta
Practitioner.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Comments

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 as much as possible.

Practitioner.language
Definition

The base language in which the resource is written.

Control0..1
Binding A human language.
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Typecode
Comments

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).

Practitioner.text
Definition

A 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.

Control1..1(See dom-1 for the conditions that apply
TypeNarrative
Must Supporttrue
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Practitioner.text.extension
Definition

May 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Practitioner.text.status
Definition

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

Control1..1
Binding The status of a resource narrative
The codes SHALL be taken from NarrativeStatus
Typecode
Must Supporttrue
Fixed Valuegenerated
Practitioner.text.div
Definition

The actual narrative content, a stripped down version of XHTML.

Control1..1
Typexhtml
Comments

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content may not contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

InvariantsDefined on this element
txt-1: The narrative SHALL contain only the basic html formatting elements described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (xpath: not(descendant-or-self::*[not(local-name(.)=('a', 'abbr', 'acronym', 'b', 'big', 'blockquote', 'br', 'caption', 'cite', 'code', 'col', 'colgroup', 'dd', 'dfn', 'div', 'dl', 'dt', 'em', 'h1', 'h2', 'h3', 'h4', 'h5', 'h6', 'hr', 'i', 'img', 'li', 'ol', 'p', 'pre', 'q', 'samp', 'small', 'span', 'strong', 'table', 'tbody', 'td', 'tfoot', 'th', 'thead', 'tr', 'tt', 'ul', 'var'))]))
txt-2: The narrative SHALL have some non-whitespace content (xpath: descendant::text()[normalize-space(.)!=''] or descendant::h:img[@src])
txt-3: The narrative SHALL contain only the basic html formatting attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (xpath: not(descendant-or-self::*/@*[not(name(.)=('abbr', 'accesskey', 'align', 'alt', 'axis', 'bgcolor', 'border', 'cellhalign', 'cellpadding', 'cellspacing', 'cellvalign', 'char', 'charoff', 'charset', 'cite', 'class', 'colspan', 'compact', 'coords', 'dir', 'frame', 'headers', 'height', 'href', 'hreflang', 'hspace', 'id', 'lang', 'longdesc', 'name', 'nowrap', 'rel', 'rev', 'rowspan', 'rules', 'scope', 'shape', 'span', 'src', 'start', 'style', 'summary', 'tabindex', 'title', 'type', 'valign', 'value', 'vspace', 'width'))]))
Practitioner.contained
Definition

These 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.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

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.

Practitioner.extension
Definition

May 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Practitioner.modifierExtension
Definition

May 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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.

Practitioner.identifier
Definition

An identifier that applies to this person in this role.

Control0..*
TypeIdentifier
Must Supporttrue
Requirements

Either id or name is needed.

Practitioner.identifier.extension
Definition

May 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Practitioner.identifier.use
Definition

The purpose of this identifier.

Control0..1
Binding Identifies the purpose for this identifier, if known .
The codes SHALL be taken from IdentifierUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Practitioner.identifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Practitioner.identifier.system
Definition

NPI could be used as the identifier system in the US.

Control1..1
Typeuri
Must Supporttrue
Requirements

There are many sequences of identifiers. To perform matching, we need to know what sequence we're dealing with. The system identifies a particular sequence or set of unique identifiers.

Comments

NPI could be used as the identifier system in the US.

ExampleNPI could be used as the identifier system in the US.
Practitioner.identifier.value
Definition

The portion of the identifier typically displayed to the user and which is unique within the context of the system.

Control1..1
Typestring
Must Supporttrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.

Example123456
Practitioner.identifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
Practitioner.identifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Comments

The reference may be just a text description of the assigner.

Practitioner.active
Definition

Whether this practitioner's record is in active use.

Control0..1
Typeboolean
Requirements

Need to be able to mark a practitioner record as not to be used because it was created in error.

Comments

Default is true. If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.

Default Valuetrue
Practitioner.name
Definition

A name associated with the person.

Control0..1
TypeHumanName
Must Supporttrue
Requirements

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that person.

Practitioner.name.extension
Definition

May 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Practitioner.name.use
Definition

Identifies the purpose for this name.

Control0..1
Binding The use of a human name
The codes SHALL be taken from NameUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate name for a particular context of use to be selected from among a set of names.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

Practitioner.name.text
Definition

A full text representation of the name.

Control0..1
Typestring
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and structured parts.

Practitioner.name.family
Definition

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

Control1..*
Typestring
Must Supporttrue
Alternate Namessurname
Comments

For family name, hyphenated names such as "Smith-Jones" are a single name, but names with spaces such as "Smith Jones" are broken into multiple parts.

Practitioner.name.given
Definition

Given name.

Control0..2
Typestring
Must Supporttrue
Alternate Namesfirst name, middle name
Comments

Can be first and middle name or initial.

Practitioner.name.prefix
Definition

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

Control0..1
Typestring
Must Supporttrue
Practitioner.name.suffix
Definition

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

Control0..1
Typestring
Must Supporttrue
Practitioner.name.period
Definition

Indicates the period of time when this name was valid for the named person.

Control0..1
TypePeriod
Requirements

Allows names to be placed in historical context.

Practitioner.telecom
Definition

A contact detail for the practitioner, e.g. a telephone number or an email address.

Control0..*
TypeContactPoint
Must Supporttrue
Requirements

Need to know how to reach a practitioner.

Comments

Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

Practitioner.telecom.extension(directAddressInd)
Definition

An Extension

Control0..*
TypeExtension(us-core-direct)
Must Supporttrue
Practitioner.telecom.system
Definition

Telecommunications form for contact point - what communications system is required to make use of the contact.

Control1..1(See cpt-2 for the conditions that apply
Binding Telecommunications form for contact point
The codes SHALL be taken from ContactPointSystem
Typecode
Must Supporttrue
Practitioner.telecom.value
Definition

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

Control1..1
Typestring
Must Supporttrue
Requirements

Need to support legacy numbers that are not in a tightly controlled format.

Comments

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

Practitioner.telecom.use
Definition

Identifies the purpose for the contact point.

Control0..1
Binding Use of contact point
The codes SHALL be taken from ContactPointUse
Typecode
Is Modifiertrue
Requirements

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one. Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Practitioner.telecom.rank
Definition

Specifies a preferred order in which to use a set of contacts. Contacts are ranked with lower values coming before higher values.

Control0..1
TypepositiveInt
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

Practitioner.telecom.period
Definition

Time period when the contact point was/is in use.

Control0..1
TypePeriod
Practitioner.address
Definition

The postal address where the practitioner can be found or visited or to which mail can be delivered.

Control0..*
TypeAddress
Requirements

Need to keep track where the practitioner can found during work or for directing mail.

Practitioner.gender
Definition

Administrative Gender - the gender that the person is considered to have for administration and record keeping purposes.

Control0..1
Binding The gender of a person used for administrative purposes.
The codes SHALL be taken from AdministrativeGender
Typecode
Requirements

Needed to address the person correctly.

Practitioner.birthDate
Definition

The date of birth for the practitioner.

Control0..1
Typedate
Requirements

Needed for identification.

Practitioner.photo
Definition

Image of the person.

Control0..*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of patients and personnel. Fits with newer social media usage too.

Practitioner.practitionerRole
Definition

The list of roles/organizations that the practitioner is associated with.

Control0..*
TypeBackboneElement
Must Supporttrue
Practitioner.practitionerRole.extension
Definition

May 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Practitioner.practitionerRole.modifierExtension
Definition

May 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Practitioner.practitionerRole.managingOrganization
Definition

The organization where the Practitioner performs the roles associated.

Control0..1
TypeReference(daf-organization)
Must Supporttrue
Practitioner.practitionerRole.role
Definition

Roles which this practitioner is authorized to perform for the organization.

Control0..1
Binding The role a person plays representing an organization
For example codes, see PractitionerRole
TypeCodeableConcept
Requirements

Need to know what authority the practitioner has - what can they do?

Comments

A person may have more than one role. At least one role is required.

Practitioner.practitionerRole.specialty
Definition

Specific specialty of the practitioner.

Control0..*
Binding Specific specialty associated with the agency
For example codes, see PractitionerSpecialty
TypeCodeableConcept
Practitioner.practitionerRole.period
Definition

The period during which the person is authorized to act as a practitioner in these role(s) for the organization.

Control0..1
TypePeriod
Requirements

Even after the agencies is revoked, the fact that it existed must still be recorded.

Practitioner.practitionerRole.location
Definition

The location(s) at which this practitioner provides care.

Control0..*
TypeReference(Location)
Practitioner.practitionerRole.healthcareService
Definition

The list of healthcare services that this worker provides for this role's Organization/Location(s).

Control0..*
TypeReference(HealthcareService)
Practitioner.qualification
Definition

Qualifications obtained by training and certification.

Control0..*
TypeBackboneElement
Practitioner.qualification.extension
Definition

May 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Practitioner.qualification.modifierExtension
Definition

May 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Practitioner.qualification.identifier
Definition

An identifier that applies to this person's qualification in this role.

Control0..*
TypeIdentifier
Requirements

Often, specific identities are assigned for the qualification.

Practitioner.qualification.code
Definition

Coded representation of the qualification.

Control1..1
Binding Specific qualification the practitioner has to provide a service
For example codes, see ANZSCO -- Australian and New Zealand Standard Classification of Occupations, 2013, Version 1.2
TypeCodeableConcept
Practitioner.qualification.period
Definition

Period during which the qualification is valid.

Control0..1
TypePeriod
Requirements

Qualifications are often for a limited period of time, and can be revoked.

Practitioner.qualification.issuer
Definition

Organization that regulates and issues the qualification.

Control0..1
TypeReference(Organization)
Practitioner.communication
Definition

A language the practitioner is able to use in patient communication.

Control0..*
Binding A human language.
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
TypeCodeableConcept
Requirements

Knowing which language a practitioner speaks can help in facilitating communication with patients.

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

 

Note that this is a DSTU2 project and so the XPath expression is given in the Practitioner element instead of a FHIRPath expression: exists(f:name) or exists(f:identifier). In DSTU2 the Xpath expression is mandatory and it is not possible to provide a FHIRPath expression. However, in STU3 a FHIRPath expression is mandatory, while the XPath expression is optional - in FHIRPath the same expression would be: name.exists() or identifier.exists()

Core StructureDefinitions STU3

This project on Simplifier contains all STU3 structure definitions that are part of the core specification. For example, there are some core VitalSigns profiles based on Observation. Below are the details of the core profile for bodyheight. The first couple of invariants (dom-1 to dom-4) in this profile are common rules for contained resources that apply to all resources. Next, there are two rules concerning the Observation resource (there can only be a data absent reason when there is no value and the value associated with a code shall be empty when the code is the same as one of the component codes). Last, there is a specific rule for the vital signs profile, which says that either a value or data absent reason shall be present when both the component and related element are missing.

In addition, there are some invariants defined on specific elements. For example, take a look at the category element. This constraint says that the category 'vital-signs' and the code system 'http://hl7.org/fhir/observation-category' should be present.

Observation
DefinitionThis profile defines how to represent Body Height observations in FHIR using a standard LOINC code and UCUM units of measure.
Cardinality0...*
AliasVital Signs, Measurement, Results, Tests
Comments

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 lab reports, etc.

Invariants
  • dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-1:If the resource is contained in another resource, it SHALL NOT contain any narrative
    contained.text.empty()
  • dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
    contained.where(('#'+id in %resource.descendants().reference).not()).empty()
  • obs-7:If code is the same as a component code then the value element associated with the code SHALL NOT be present
    value.empty() or code!=component.code
  • obs-6:dataAbsentReason SHALL only be present if Observation.value[x] is not present
    dataAbsentReason.empty() or value.empty()
  • vs-2:If there is no component or related element then either a value[x] or a data absent reason must be present
    (component.empty() and related.empty()) implies (dataAbsentReason or value)
Mappings
  • rim:Entity. Role, or Act
  • workflow:Event
  • sct-concept:< 363787002 |Observable entity|
  • v2:OBX
  • rim:Observation[classCode=OBS, moodCode=EVN]
  • w5:clinical.diagnostics
Observation.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typeid
SummaryTrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Observation.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Observation.implicitRules
DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

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.

Observation.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Bindinglanguages (extensible)
Comments

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).

Observation.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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.

Mappings
  • rim:Act.text?
Observation.contained
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.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

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.

Mappings
  • rim:N/A
Observation.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

Mappings
  • rim:N/A
Observation.modifierExtension
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.
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Comments

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.

Mappings
  • rim:N/A
Observation.identifier
DefinitionA unique identifier assigned to this observation.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Allows observations to be distinguished and referenced.

Mappings
  • workflow:Event.identifier
  • v2: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.
  • rim:id
  • w5:id
Observation.basedOn
DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event.
Cardinality0...*
TypeReference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)
SummaryTrue
AliasFulfills
Requirements

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

Mappings
  • workflow:Event.basedOn
  • v2:ORC
  • rim:.outboundRelationship[typeCode=FLFS].target
Observation.status
DefinitionThe status of the result value.
Cardinality1...1
Typecode
Bindingobservation-status (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Need to track the status of individual results. Some results are finalized before the whole report is finalized.

Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Mappings
  • workflow:Event.status
  • sct-concept:< 445584004 |Report by finality status|
  • v2:OBX-11
  • rim:status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
  • w5:status
Observation.category
DefinitionA code that classifies the general type of observation being made.
Cardinality1...*
TypeCodeableConcept
Bindingobservation-category (preferred)
Must SupportTrue
Requirements

Used for filtering what observations are retrieved and displayed.

Comments

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.

Invariants
  • vs-4:Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
    where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()
Mappings
  • rim:.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
  • w5:class
Observation.code
DefinitionBody Height.
Cardinality1...1
TypeCodeableConcept
Bindingobservation-vitalsignresult (extensible)
Must SupportTrue
SummaryTrue
AliasName, Test, Name
Requirements
  1. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).
Comments

additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

Mappings
  • workflow:Event.code
  • sct-concept:< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
  • v2:OBX-3
  • rim:code
  • sct-attr:116680003 |Is a|
  • w5:what
Observation.code.id
Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim:n/a
Observation.code.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Mappings
  • rim:n/a
Observation.code.coding
DefinitionA reference to a code defined by a terminology system.
Cardinality0...*
TypeCoding
SummaryTrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

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.

SlicingUnordered, Open, by code(Value)
Mappings
  • v2:C*E.1-8, C*E.10-22
  • rim:union(., ./translation)
  • orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Observation.code.coding:bodyheightcode
DefinitionA reference to a code defined by a terminology system.
Cardinality0...*
TypeCoding
SummaryTrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

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.

Mappings
  • v2:C*E.1-8, C*E.10-22
  • rim:union(., ./translation)
  • orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Observation.code.coding:bodyheightcode.id
Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim:n/a
Observation.code.coding:bodyheightcode.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Mappings
  • rim:n/a
Observation.code.coding:bodyheightcode.system
DefinitionThe identification of the code system that defines the meaning of the symbol in the code.
Cardinality0...1
Typeuri
SummaryTrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

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.

Fixed Value
http://loinc.org
Mappings
  • v2:C*E.3
  • rim:./codeSystem
  • orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
Observation.code.coding:bodyheightcode.version
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.
Cardinality0...1
Typestring
SummaryTrue
Comments

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.

Mappings
  • v2:C*E.7
  • rim:./codeSystemVersion
  • orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
Observation.code.coding:bodyheightcode.code
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).
Cardinality0...1
Typecode
SummaryTrue
Requirements

Need to refer to a particular code in the system.

Fixed Value
8302-2
Mappings
  • v2:C*E.1
  • rim:./code
  • orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
Observation.code.coding:bodyheightcode.display
DefinitionA representation of the meaning of the code in the system, following the rules of the system.
Cardinality0...1
Typestring
SummaryTrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Mappings
  • v2:C*E.2 - but note this is not well followed
  • rim:CV.displayName
  • orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
Observation.code.coding:bodyheightcode.userSelected
DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).
Cardinality0...1
Typeboolean
SummaryTrue
Requirements

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.

Comments

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.

Mappings
  • v2:Sometimes implied by being first
  • rim:CD.codingRationale
  • orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Observation.code.text
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.
Cardinality0...1
Typestring
SummaryTrue
Requirements

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.

Comments

Very often the text is the same as a displayName of one of the codings.

Mappings
  • v2:C*E.9. But note many systems use C*E.2 for this
  • rim:./originalText[mediaType/code="text/plain"]/data
  • orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Observation.subject
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.
Cardinality1...1
TypeReference(Patient)
Must SupportTrue
SummaryTrue
Requirements

Observations have no value if you don't know who or what they're about.

Comments

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.

Mappings
  • workflow:Event.subject
  • v2:PID-3
  • rim:participation[typeCode=SBJ]
  • w5:who.focus
Observation.context
DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
Cardinality0...1
TypeReference(Encounter | EpisodeOfCare)
AliasEncounter
Requirements

For some observations it may be important to know the link between an observation and a particular encounter.

Comments

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).

Mappings
  • workflow:Event.context
  • v2:PV1
  • rim:inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
  • w5:context
Observation.effective[x]
DefinitionOften just a dateTime for Vital Signs.
Cardinality1...1
TypedateTime, Period
Must SupportTrue
SummaryTrue
AliasOccurrence
Requirements

Knowing when an observation was deemed true is important to its relevance as well as determining trends.

Comments

At least a date should be present unless this observation is a historical report.

Invariants
  • vs-1:Datetime must be at least to day.
    ($this as dateTime).toString().length() >= 8
Mappings
  • workflow:Event.occurrence[x]
  • v2:OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
  • rim:effectiveTime
  • w5:when.done
Observation.issued
DefinitionThe date and time this observation was made available to providers, typically after the results have been reviewed and verified.
Cardinality0...1
Typeinstant
SummaryTrue
Comments

Updated when the result is updated.

Mappings
  • v2:OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)
  • rim:participation[typeCode=AUT].time
  • w5:when.recorded
Observation.performer
DefinitionWho was responsible for asserting the observed value as "true".
Cardinality0...*
TypeReference(Practitioner | Organization | Patient | RelatedPerson)
SummaryTrue
Requirements

May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

Mappings
  • workflow:Event.performer
  • v2: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'
  • rim:participation[typeCode=PRF]
  • w5:who.actor
Observation.valueQuantity
DefinitionVital Sign Value recorded with UCUM.
Cardinality0...1
TypeQuantity
Bindingucum-vitals-common (required)
Must SupportTrue
SummaryTrue
Requirements
  1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
Comments

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.

Mappings
  • workflow:Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason)
  • sct-concept:< 441742003 |Evaluation finding|
  • v2:OBX.2, OBX.5, OBX.6
  • rim:value
  • sct-attr:363714003 |Interprets|
Observation.valueQuantity.id
Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim:n/a
Observation.valueQuantity.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Mappings
  • rim:n/a
Observation.valueQuantity.value
DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value.
Cardinality1...1
Typedecimal
Must SupportTrue
SummaryTrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

Mappings
  • v2:SN.2 / CQ - N/A
  • rim:PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
Observation.valueQuantity.comparator
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.
Cardinality0...1
Typecode
Bindingquantity-comparator (required)
ModifierTrue
SummaryTrue
Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

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.

Mappings
  • v2:SN.1 / CQ.1
  • rim:IVL properties
Observation.valueQuantity.unit
DefinitionA human-readable form of the unit.
Cardinality1...1
Typestring
Must SupportTrue
SummaryTrue
Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Mappings
  • v2:(see OBX.6 etc.) / CQ.2
  • rim:PQ.unit
Observation.valueQuantity.system
DefinitionThe identification of the system that provides the coded form of the unit.
Cardinality1...1
Typeuri
Must SupportTrue
SummaryTrue
Requirements

Need to know the system that defines the coded form of the unit.

Fixed Value
http://unitsofmeasure.org
Mappings
  • v2:(see OBX.6 etc.) / CQ.2
  • rim:CO.codeSystem, PQ.translation.codeSystem
Observation.valueQuantity.code
DefinitionCoded responses from the common UCUM units for vital signs value set.
Cardinality1...1
Typecode
Bindingucum-bodylength (required)
Must SupportTrue
SummaryTrue
Requirements

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.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Mappings
  • v2:(see OBX.6 etc.) / CQ.2
  • rim:PQ.code, MO.currency, PQ.translation.code
Observation.dataAbsentReason
DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing.
Cardinality0...1
TypeCodeableConcept
Bindingobservation-valueabsentreason (extensible)
Must SupportTrue
Requirements

For many results it is necessary to handle exceptional values in measurements.

Comments

Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

Mappings
  • workflow:Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason)
  • v2:N/A
  • rim:value.nullFlavor
Observation.interpretation
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.
Cardinality0...1
TypeCodeableConcept
Bindingobservation-interpretation (extensible)
AliasAbnormal Flag
Requirements

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Mappings
  • sct-concept:< 260245000 |Findings values|
  • v2:OBX-8
  • rim:interpretationCode
  • sct-attr:363713009 |Has interpretation|
Observation.comment
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.
Cardinality0...1
Typestring
Requirements

Need to be able to provide free text additional information.

Mappings
  • workflow:Event.note
  • v2:NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)
  • rim:subjectOf.observationEvent[code="annotation"].value
Observation.bodySite
DefinitionIndicates the site on the subject's body where the observation was made (i.e. the target site).
Cardinality0...1
TypeCodeableConcept
Bindingbody-site (example)
Comments

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.

Mappings
  • sct-concept:< 123037004 |Body structure|
  • v2:OBX-20
  • rim:targetSiteCode
  • sct-attr:718497002 |Inherent location|
Observation.method
DefinitionIndicates the mechanism used to perform the observation.
Cardinality0...1
TypeCodeableConcept
Bindingobservation-methods (example)
Requirements

In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

Comments

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

Mappings
  • v2:OBX-17
  • rim:methodCode
Observation.specimen
DefinitionThe specimen that was used when this observation was made.
Cardinality0...1
TypeReference(Specimen)
Comments

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).

Mappings
  • sct-concept:< 123038009 |Specimen|
  • v2:SPM segment
  • rim:participation[typeCode=SPC].specimen
  • sct-attr:704319004 |Inherent in|
Observation.device
DefinitionThe device used to generate the observation data.
Cardinality0...1
TypeReference(Device | DeviceMetric)
Comments

An extension should be used if further typing of the device is needed. Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element.

Mappings
  • sct-concept:< 49062001 |Device|
  • v2:OBX-17 / PRT -10
  • rim:participation[typeCode=DEV]
  • sct-attr:424226004 |Using device|
Observation.referenceRange
DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range.
Cardinality0...*
TypeBackboneElement
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.

Comments

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.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    children().count() > id.count()
  • obs-3:Must have at least a low or a high or text
    low.exists() or high.exists() or text.exists()
Mappings
  • v2:OBX.7
  • rim:outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
Observation.referenceRange.id
Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim:n/a
Observation.referenceRange.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

Mappings
  • rim:n/a
Observation.referenceRange.modifierExtension
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.
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Comments

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.

Mappings
  • rim:N/A
Observation.referenceRange.low
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).
Cardinality0...1
TypeSimpleQuantity
Mappings
  • v2:OBX-7
  • rim:value:IVL_PQ.low
Observation.referenceRange.high
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).
Cardinality0...1
TypeSimpleQuantity
Mappings
  • v2:OBX-7
  • rim:value:IVL_PQ.high
Observation.referenceRange.type
DefinitionCodes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
Cardinality0...1
TypeCodeableConcept
Bindingreferencerange-meaning (extensible)
Requirements

Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation.

Comments

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

Mappings
  • sct-concept:< 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
  • v2:OBX-10
  • rim:interpretationCode
Observation.referenceRange.appliesTo
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.
Cardinality0...*
TypeCodeableConcept
Bindingreferencerange-appliesto (example)
Requirements

Need to be able to identify the target population for proper interpretation.

Comments

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

Mappings
  • sct-concept:< 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
  • v2:OBX-10
  • rim:interpretationCode
Observation.referenceRange.age
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.
Cardinality0...1
TypeRange
Requirements

Some analytes vary greatly over age.

Mappings
  • rim:outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value
Observation.referenceRange.text
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'.
Cardinality0...1
Typestring
Mappings
  • v2:OBX-7
  • rim:value:ST
Observation.related
DefinitionUsed when reporting vital signs panel components.
Cardinality0...*
TypeBackboneElement
Must SupportTrue
SummaryTrue
Requirements

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.

Comments

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

Invariants
  • ele-1:All FHIR elements must have a @value or children
    children().count() > id.count()
Mappings
  • v2:Relationships established by OBX-4 usage
  • rim:outBoundRelationship
Observation.related.id
Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim:n/a
Observation.related.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

Mappings
  • rim:n/a
Observation.related.modifierExtension
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.
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Comments

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.

Mappings
  • rim:N/A
Observation.related.type
DefinitionA code specifying the kind of relationship that exists with the target resource.
Cardinality1...1
Typecode
Bindingobservation-relationshiptypes (required)
Must SupportTrue
Requirements

A relationship type SHOULD be provided.

Comments

The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource.

Fixed Value
has-member
Mappings
  • v2:N/A
  • rim:.typeCode
Observation.related.target
DefinitionA reference to the observation or [QuestionnaireResponse](questionnaireresponse.html#) resource that is related to this observation.
Cardinality1...1
TypeReference(VitalSigns)
Must SupportTrue
Mappings
  • rim:.targetObservation
Observation.component
DefinitionUsed when reporting systolic and diastolic blood pressure.
Cardinality0...*
TypeBackboneElement
Must SupportTrue
SummaryTrue
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.

Comments

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

Invariants
  • ele-1:All FHIR elements must have a @value or children
    children().count() > id.count()
  • vs-3:If there is no a value a data absent reason must be present
    value.exists() or dataAbsentReason.exists()
Mappings
  • v2:containment by OBX-4?
  • rim:outBoundRelationship[typeCode=COMP]
Observation.component.id
Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim:n/a
Observation.component.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

Mappings
  • rim:n/a
Observation.component.modifierExtension
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.
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Comments

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.

Mappings
  • rim:N/A
Observation.component.code
DefinitionDescribes what was observed. Sometimes this is called the observation "code".
Cardinality1...1
TypeCodeableConcept
Bindingobservation-vitalsignresult (extensible)
Must SupportTrue
SummaryTrue
Requirements

Knowing what kind of observation is being made is essential to understanding the observation.

Mappings
  • sct-concept:< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
  • v2:OBX-3
  • rim:code
  • w5:what
Observation.component.valueQuantity
DefinitionVital Sign Value recorded with UCUM.
Cardinality0...1
TypeQuantity
Bindingucum-vitals-common (required)
Must SupportTrue
SummaryTrue
Requirements
  1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
Comments

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).

Mappings
  • sct-concept:363714003 |Interprets| < 441742003 |Evaluation finding|
  • v2:OBX.2, OBX.5, OBX.6
  • rim:value
  • sct-attr:363714003 |Interprets|
Observation.component.valueQuantity.id
Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim:n/a
Observation.component.valueQuantity.extension
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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Mappings
  • rim:n/a
Observation.component.valueQuantity.value
DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value.
Cardinality1...1
Typedecimal
Must SupportTrue
SummaryTrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

Mappings
  • v2:SN.2 / CQ - N/A
  • rim:PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
Observation.component.valueQuantity.comparator
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.
Cardinality0...1
Typecode
Bindingquantity-comparator (required)
ModifierTrue
SummaryTrue
Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

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.

Mappings
  • v2:SN.1 / CQ.1
  • rim:IVL properties
Observation.component.valueQuantity.unit
DefinitionA human-readable form of the unit.
Cardinality1...1
Typestring
Must SupportTrue
SummaryTrue
Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Mappings
  • v2:(see OBX.6 etc.) / CQ.2
  • rim:PQ.unit
Observation.component.valueQuantity.system
DefinitionThe identification of the system that provides the coded form of the unit.
Cardinality1...1
Typeuri
Must SupportTrue
SummaryTrue
Requirements

Need to know the system that defines the coded form of the unit.

Fixed Value
http://unitsofmeasure.org
Mappings
  • v2:(see OBX.6 etc.) / CQ.2
  • rim:CO.codeSystem, PQ.translation.codeSystem
Observation.component.valueQuantity.code
DefinitionCoded responses from the common UCUM units for vital signs value set.
Cardinality1...1
Typecode
Must SupportTrue
SummaryTrue
Requirements

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.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Mappings
  • v2:(see OBX.6 etc.) / CQ.2
  • rim:PQ.code, MO.currency, PQ.translation.code
Observation.component.dataAbsentReason
DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing.
Cardinality0...1
TypeCodeableConcept
Bindingobservation-valueabsentreason (extensible)
Must SupportTrue
Requirements

For many results it is necessary to handle exceptional values in measurements.

Comments

"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.

Mappings
  • v2:N/A
  • rim:value.nullFlavor
Observation.component.interpretation
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.
Cardinality0...1
TypeCodeableConcept
Bindingobservation-interpretation (extensible)
AliasAbnormal Flag
Requirements

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Comments

The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

Mappings
  • sct-concept:< 260245000 |Findings values|
  • v2:OBX-8
  • rim:interpretationCode
  • sct-attr:363713009 |Has interpretation|
Observation.component.referenceRange
DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range.
Cardinality0...*
Typesee (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.

Comments

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.

Mappings
  • v2:OBX.7
  • rim:outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

 

Below is the XML code of this profile. Scroll down to view the FHIRPath expressions for these constraints.

<StructureDefinition>
    <id value="bodyheight" />
    <text>
        <status value="generated" />
        --- We have skipped the narrative for rendering purposes ---
    </text>
    <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-summary">
        <valueMarkdown value="####Complete Summary of the Mandatory Requirements

1.  One code in `Observation.code` which must have
    -   a fixed `Observation.code.coding.system`=**'http ://loinc.org'**
    -   a fixed  `Observation.code.coding.code`= **'8302-2'**
    -   Other additional codes are allowed - e.g. more specific LOINC
        Codes, SNOMED CT concepts, system specific codes. All codes
        SHALL have an system value
2.  a fixed`Observation.valueQuantity.code` = **'cm', or '[in_i]'**" />
    </extension>
    <url value="http://hl7.org/fhir/StructureDefinition/bodyheight" />
    <name value="Vital Signs Profile" />
    <title value="VitalSigns" />
    <status value="draft" />
    <experimental value="false" />
    <publisher value="Health Level Seven International (Orders and Observations Workgroup)" />
    <contact>
        <telecom>
            <system value="url" />
            <value value="http://www.hl7.org/Special/committees/orders/index.cfm Orders and Observations" />
        </telecom>
    </contact>
    <description value="FHIR Body Height Profile" />
    <fhirVersion value="3.0.0" />
    <mapping>
        <identity value="workflow" />
        <uri value="http://hl7.org/fhir/workflow" />
        <name value="Workflow Mapping" />
    </mapping>
    <mapping>
        <identity value="sct-concept" />
        <uri value="http://snomed.info/conceptdomain" />
        <name value="SNOMED CT Concept Domain Binding" />
    </mapping>
    <mapping>
        <identity value="v2" />
        <uri value="http://hl7.org/v2" />
        <name value="HL7 v2 Mapping" />
    </mapping>
    <mapping>
        <identity value="rim" />
        <uri value="http://hl7.org/v3" />
        <name value="RIM Mapping" />
    </mapping>
    <mapping>
        <identity value="w5" />
        <uri value="http://hl7.org/fhir/w5" />
        <name value="W5 Mapping" />
    </mapping>
    <mapping>
        <identity value="sct-attr" />
        <uri value="http://snomed.info/sct" />
        <name value="SNOMED CT Attribute Binding" />
    </mapping>
    <kind value="resource" />
    <abstract value="false" />
    <type value="Observation" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/vitalsigns" />
    <derivation value="constraint" />
    <snapshot>
        <element id="Observation">
            <path value="Observation" />
            <short value="FHIR Body Height Profile" />
            <definition value="This profile defines  how to represent Body Height observations in FHIR using a standard LOINC code and UCUM units of measure." />
            <comment value="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 lab reports, etc." />
            <alias value="Vital Signs" />
            <alias value="Measurement" />
            <alias value="Results" />
            <alias value="Tests" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation" />
                <min value="0" />
                <max value="*" />
            </base>
            <constraint>
                <key value="dom-2" />
                <severity value="error" />
                <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
                <expression value="contained.contained.empty()" />
                <xpath value="not(parent::f:contained and f:contained)" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="dom-1" />
                <severity value="error" />
                <human value="If the resource is contained in another resource, it SHALL NOT contain any narrative" />
                <expression value="contained.text.empty()" />
                <xpath value="not(parent::f:contained and f:text)" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="dom-4" />
                <severity value="error" />
                <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
                <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
                <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="dom-3" />
                <severity value="error" />
                <human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource" />
                <expression value="contained.where(('#'+id in %resource.descendants().reference).not()).empty()" />
                <xpath value="not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="obs-7" />
                <severity value="error" />
                <human value="If code is the same as a component code then the value element associated with the code SHALL NOT be present" />
                <expression value="value.empty() or code!=component.code" />
                <xpath value="not(exists(f:*[starts-with(local-name(.), 'value')])) or not(count(for $coding in f:code/f:coding return parent::*/f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value and f:system/@value=$coding/f:system/@value])=0)" />
                <source value="Observation" />
            </constraint>
            <constraint>
                <key value="obs-6" />
                <severity value="error" />
                <human value="dataAbsentReason SHALL only be present if Observation.value[x] is not present" />
                <expression value="dataAbsentReason.empty() or value.empty()" />
                <xpath value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))" />
                <source value="Observation" />
            </constraint>
            <constraint>
                <key value="vs-2" />
                <severity value="error" />
                <human value="If there is no component or related element then either a value[x] or a data absent reason must be present" />
                <expression value="(component.empty() and related.empty()) implies (dataAbsentReason or value)" />
                <xpath value="exists(f:component) or exists(f:related) or exists(f:*[starts-with(local-name(.), 'value')]) or exists(f:dataAbsentReason)" />
                <source value="Observation" />
            </constraint>
            <mapping>
                <identity value="rim" />
                <map value="Entity. Role, or Act" />
            </mapping>
            <mapping>
                <identity value="workflow" />
                <map value="Event" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 363787002 |Observable entity|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="Observation[classCode=OBS, moodCode=EVN]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="clinical.diagnostics" />
            </mapping>
        </element>
        <element id="Observation.id">
            <path value="Observation.id" />
            <short value="Logical id of this artifact" />
            <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
            <comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="id" />
            </type>
            <isSummary value="true" />
        </element>
        <element id="Observation.meta">
            <path value="Observation.meta" />
            <short value="Metadata about the resource" />
            <definition value="The 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." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.meta" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Meta" />
            </type>
            <isSummary value="true" />
        </element>
        <element id="Observation.implicitRules">
            <path value="Observation.implicitRules" />
            <short value="A set of rules under which this content was created" />
            <definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content." />
            <comment value="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." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.implicitRules" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="uri" />
            </type>
            <isModifier value="true" />
            <isSummary value="true" />
        </element>
        <element id="Observation.language">
            <path value="Observation.language" />
            <short value="Language of the resource content" />
            <definition value="The base language in which the resource is written." />
            <comment value="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)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.language" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
                    <valueReference>
                        <reference value="http://hl7.org/fhir/ValueSet/all-languages" />
                    </value>
                </extension>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="Language" />
                </extension>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
                    <valueBoolean value="true" />
                </extension>
                <strength value="extensible" />
                <description value="A human language." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/languages" />
                </valueSet>
            </binding>
        </element>
        <element id="Observation.text">
            <path value="Observation.text" />
            <short value="Text summary of the resource, for human interpretation" />
            <definition value="A 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." />
            <comment value="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." />
            <alias value="narrative" />
            <alias value="html" />
            <alias value="xhtml" />
            <alias value="display" />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="DomainResource.text" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Narrative" />
            </type>
            <condition value="dom-1" />
            <mapping>
                <identity value="rim" />
                <map value="Act.text?" />
            </mapping>
        </element>
        <element id="Observation.contained">
            <path value="Observation.contained" />
            <short value="Contained, inline Resources" />
            <definition value="These 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." />
            <comment value="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." />
            <alias value="inline resources" />
            <alias value="anonymous resources" />
            <alias value="contained resources" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="DomainResource.contained" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Resource" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.extension">
            <path value="Observation.extension" />
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="DomainResource.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.modifierExtension">
            <path value="Observation.modifierExtension" />
            <short value="Extensions that cannot be ignored" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="DomainResource.modifierExtension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <isModifier value="true" />
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.identifier">
            <path value="Observation.identifier" />
            <short value="Business Identifier for observation" />
            <definition value="A unique identifier assigned to this observation." />
            <requirements value="Allows observations to be distinguished and referenced." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.identifier" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Identifier" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.identifier" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="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." />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="id" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="id" />
            </mapping>
        </element>
        <element id="Observation.basedOn">
            <path value="Observation.basedOn" />
            <short value="Fulfills plan, proposal or order" />
            <definition value="A plan, proposal or order that is fulfilled in whole or in part by this event." />
            <requirements value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon." />
            <alias value="Fulfills" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.basedOn" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceRequest" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/NutritionOrder" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/ProcedureRequest" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/ReferralRequest" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.basedOn" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="ORC" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value=".outboundRelationship[typeCode=FLFS].target" />
            </mapping>
        </element>
        <element id="Observation.status">
            <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
                <valueString value="default: final" />
            </extension>
            <path value="Observation.status" />
            <short value="registered | preliminary | final | amended +" />
            <definition value="The status of the result value." />
            <comment value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." />
            <requirements value="Need to track the status of individual results. Some results are finalized before the whole report is finalized." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.status" />
                <min value="1" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <mustSupport value="true" />
            <isModifier value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="Status" />
                </extension>
                <strength value="required" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-status" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.status" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 445584004 |Report by finality status|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-11" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="status  Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="status" />
            </mapping>
        </element>
        <element id="Observation.category">
            <path value="Observation.category" />
            <short value="Classification of  type of observation" />
            <definition value="A code that classifies the general type of observation being made." />
            <comment value="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." />
            <requirements value="Used for filtering what observations are retrieved and displayed." />
            <min value="1" />
            <max value="*" />
            <base>
                <path value="Observation.category" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <constraint>
                <key value="vs-4" />
                <severity value="error" />
                <human value="Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'" />
                <expression value="where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()" />
                <xpath value="exists(f:coding/code[@value='vital-signs']) and exists(f:coding/system[@value='http://hl7.org/fhir/observation-category'])" />
            </constraint>
            <mustSupport value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationCategory" />
                </extension>
                <strength value="preferred" />
                <description value="Codes for high level observation categories." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-category" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="rim" />
                <map value=".outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="class" />
            </mapping>
        </element>
        <element id="Observation.code">
            <path value="Observation.code" />
            <short value="Body Height" />
            <definition value="Body Height." />
            <comment value="additional codes that translate or map to this code are allowed.  For example a more granular LOINC code or code that is used locally in a system." />
            <requirements value="5. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301)." />
            <alias value="Name" />
            <alias value="Test" />
            <alias value="Name" />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.code" />
                <min value="1" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="VitalSigns" />
                </extension>
                <strength value="extensible" />
                <description value="This identifies the vital sign result type." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-vitalsignresult" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.code" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-3" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="code" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="116680003 |Is a|" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="what" />
            </mapping>
        </element>
        <element id="Observation.code.id">
            <path value="Observation.code.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.extension">
            <path value="Observation.code.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <description value="Extensions are always sliced by (at least) url" />
                <rules value="open" />
            </slicing>
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.coding">
            <path value="Observation.code.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="code" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <short value="Code defined by a terminology system" />
            <definition value="A reference to a code defined by a terminology system." />
            <comment value="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." />
            <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="CodeableConcept.coding" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Coding" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.1-8, C*E.10-22" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="union(., ./translation)" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode">
            <path value="Observation.code.coding" />
            <sliceName value="BodyHeightCode" />
            <short value="Code defined by a terminology system" />
            <definition value="A reference to a code defined by a terminology system." />
            <comment value="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." />
            <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="CodeableConcept.coding" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Coding" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.1-8, C*E.10-22" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="union(., ./translation)" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.id">
            <path value="Observation.code.coding.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.extension">
            <path value="Observation.code.coding.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <description value="Extensions are always sliced by (at least) url" />
                <rules value="open" />
            </slicing>
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.system">
            <path value="Observation.code.coding.system" />
            <short value="Identity of the terminology system" />
            <definition value="The identification of the code system that defines the meaning of the symbol in the code." />
            <comment value="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." />
            <requirements value="Need to be unambiguous about the source of the definition of the symbol." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.system" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="uri" />
            </type>
            <fixedUri value="http://loinc.org" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.3" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./codeSystem" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.version">
            <path value="Observation.code.coding.version" />
            <short value="Version of the system - if relevant" />
            <definition value="The 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." />
            <comment value="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." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.version" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./codeSystemVersion" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.code">
            <path value="Observation.code.coding.code" />
            <short value="Symbol in syntax defined by the system" />
            <definition value="A 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)." />
            <requirements value="Need to refer to a particular code in the system." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.code" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <fixedCode value="8302-2" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.1" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./code" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.display">
            <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
                <valueBoolean value="true" />
            </extension>
            <path value="Observation.code.coding.display" />
            <short value="Representation defined by the system" />
            <definition value="A representation of the meaning of the code in the system, following the rules of the system." />
            <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know  the system." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.display" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.2 - but note this is not well followed" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="CV.displayName" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.userSelected">
            <path value="Observation.code.coding.userSelected" />
            <short value="If this coding was chosen directly by the user" />
            <definition value="Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays)." />
            <comment value="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." />
            <requirements value="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." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.userSelected" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="boolean" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="Sometimes implied by being first" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="CD.codingRationale" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source "true";     fhir:target dt:CDCoding.codingRationale\#O   ]" />
            </mapping>
        </element>
        <element id="Observation.code.text">
            <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
                <valueBoolean value="true" />
            </extension>
            <path value="Observation.code.text" />
            <short value="Plain text representation of the concept" />
            <definition value="A 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." />
            <comment value="Very often the text is the same as a displayName of one of the codings." />
            <requirements value="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." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="CodeableConcept.text" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.9. But note many systems use C*E.2 for this" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./originalText[mediaType/code="text/plain"]/data" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" />
            </mapping>
        </element>
        <element id="Observation.subject">
            <path value="Observation.subject" />
            <short value="Who and/or what this is about" />
            <definition value="The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.  Comments: Indirect characteristics may be those of a specimen, fetus, donor,  other observer (for example a relative or EMT), or any observation made about the subject." />
            <comment value="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](extension-observation-focal-subject.html).  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." />
            <requirements value="Observations have no value if you don't know who or what they're about." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.subject" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.subject" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="PID-3" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=SBJ]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="who.focus" />
            </mapping>
        </element>
        <element id="Observation.context">
            <path value="Observation.context" />
            <short value="Healthcare event during which this observation is made" />
            <definition value="The healthcare event  (e.g. a patient and healthcare provider interaction) during which this observation is made." />
            <comment value="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)." />
            <requirements value="For some observations it may be important to know the link between an observation and a particular encounter." />
            <alias value="Encounter" />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.context" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare" />
            </type>
            <mapping>
                <identity value="workflow" />
                <map value="Event.context" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="PV1" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="context" />
            </mapping>
        </element>
        <element id="Observation.effective[x]">
            <path value="Observation.effective[x]" />
            <short value="Often just a dateTime for Vital Signs" />
            <definition value="Often just a dateTime for Vital Signs." />
            <comment value="At least a date should be present unless this observation is a historical report." />
            <requirements value="Knowing when an observation was deemed true is important to its relevance as well as determining trends." />
            <alias value="Occurrence" />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.effective[x]" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="dateTime" />
            </type>
            <type>
                <code value="Period" />
            </type>
            <constraint>
                <key value="vs-1" />
                <severity value="error" />
                <human value="Datetime must be at least to day." />
                <expression value="($this as dateTime).toString().length() >= 8" />
                <xpath value="f:matches(effectiveDateTime,/\d{4}-[01]\d-[0-3]\dT[0-2]\d:[0-5]\d([+-][0-2]\d:[0-5]\d|Z)/)" />
            </constraint>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.occurrence[x]" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-14, and/or OBX-19 after v2.4  (depends on who observation made)" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="effectiveTime" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="when.done" />
            </mapping>
        </element>
        <element id="Observation.issued">
            <path value="Observation.issued" />
            <short value="Date/Time this was made available" />
            <definition value="The date and time this observation was made available to providers, typically after the results have been reviewed and verified." />
            <comment value="Updated when the result is updated." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.issued" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="instant" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=AUT].time" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="when.recorded" />
            </mapping>
        </element>
        <element id="Observation.performer">
            <path value="Observation.performer" />
            <short value="Who is responsible for the observation" />
            <definition value="Who was responsible for asserting the observed value as "true"." />
            <requirements value="May give a degree of confidence in the observation and also indicates where follow-up questions should be directed." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.performer" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.performer" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="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'" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=PRF]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="who.actor" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity">
            <path value="Observation.valueQuantity" />
            <short value="Vital Sign Value recorded with UCUM" />
            <definition value="Vital Sign Value recorded with UCUM." />
            <comment value="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](observation.html#notes) below." />
            <requirements value="9. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.value[x]" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Quantity" />
            </type>
            <condition value="obs-7" />
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="VitalSignsUnits" />
                </extension>
                <strength value="required" />
                <description value="Common UCUM units for recording Vital Signs" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/ucum-vitals-common" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.notDone, Event.notDoneReason  (maps to valeu[x] or dataAbsentReason)" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 441742003 |Evaluation finding|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX.2, OBX.5, OBX.6" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="363714003 |Interprets|" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.id">
            <path value="Observation.valueQuantity.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.extension">
            <path value="Observation.valueQuantity.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <description value="Extensions are always sliced by (at least) url" />
                <rules value="open" />
            </slicing>
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.value">
            <path value="Observation.valueQuantity.value" />
            <short value="Numerical value (with implicit precision)" />
            <definition value="The value of the measured amount. The value includes an implicit precision in the presentation of the value." />
            <comment value="The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books)." />
            <requirements value="Precision is handled implicitly in almost all cases of measurement." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.value" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="decimal" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="SN.2  / CQ - N/A" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.comparator">
            <path value="Observation.valueQuantity.comparator" />
            <short value="< | <= | >= | > - how to understand the value" />
            <definition value="How 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." />
            <comment value="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." />
            <requirements value="Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Quantity.comparator" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <meaningWhenMissing value="If there is no comparator, then there is no modification of the value" />
            <isModifier value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="QuantityComparator" />
                </extension>
                <strength value="required" />
                <description value="How the Quantity should be understood and represented." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/quantity-comparator" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="SN.1  / CQ.1" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="IVL properties" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.unit">
            <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
                <valueBoolean value="true" />
            </extension>
            <path value="Observation.valueQuantity.unit" />
            <short value="Unit representation" />
            <definition value="A human-readable form of the unit." />
            <requirements value="There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.unit" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.unit" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.system">
            <path value="Observation.valueQuantity.system" />
            <short value="System that defines coded unit form" />
            <definition value="The identification of the system that provides the coded form of the unit." />
            <requirements value="Need to know the system that defines the coded form of the unit." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.system" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="uri" />
            </type>
            <fixedUri value="http://unitsofmeasure.org" />
            <condition value="qty-3" />
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="CO.codeSystem, PQ.translation.codeSystem" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.code">
            <path value="Observation.valueQuantity.code" />
            <short value="Coded responses from the common UCUM units for vital signs value set." />
            <definition value="Coded responses from the common UCUM units for vital signs value set." />
            <comment value="The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency.  The context of use may additionally require a code from a particular system." />
            <requirements value="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." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.code" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="BodyLengthUnits" />
                </extension>
                <strength value="required" />
                <description value="Common UCUM units for Body Length measures such as Body Height and Head Circumference" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/ucum-bodylength" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.code, MO.currency, PQ.translation.code" />
            </mapping>
        </element>
        <element id="Observation.dataAbsentReason">
            <path value="Observation.dataAbsentReason" />
            <short value="Why the result is missing" />
            <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing." />
            <comment value="Null or exceptional values can be represented two ways in FHIR Observations.  One way is to simply include them in the value set and represent the exceptions in the value.  For example, measurement values for a serology test could be  "detected", "not detected", "inconclusive", or  "specimen unsatisfactory".   The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0.  Because of these options, use-case agreements are required to interpret general observations for null or exceptional values." />
            <requirements value="For many results it is necessary to handle exceptional values in measurements." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.dataAbsentReason" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <condition value="obs-6" />
            <mustSupport value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="DAR" />
                </extension>
                <strength value="extensible" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.notDone, Event.notDoneReason  (maps to valeu[x] or dataAbsentReason)" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="N/A" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value.nullFlavor" />
            </mapping>
        </element>
        <element id="Observation.interpretation">
            <path value="Observation.interpretation" />
            <short value="High, low, normal, etc." />
            <definition value="The 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." />
            <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result." />
            <alias value="Abnormal Flag" />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.interpretation" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationInterpretation" />
                </extension>
                <strength value="extensible" />
                <description value="Codes identifying interpretations of observations." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-interpretation" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 260245000 |Findings values|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-8" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="interpretationCode" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="363713009 |Has interpretation|" />
            </mapping>
        </element>
        <element id="Observation.comment">
            <path value="Observation.comment" />
            <short value="Comments about result" />
            <definition value="May 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." />
            <requirements value="Need to be able to provide free text additional information." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.comment" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="workflow" />
                <map value="Event.note" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="subjectOf.observationEvent[code="annotation"].value" />
            </mapping>
        </element>
        <element id="Observation.bodySite">
            <path value="Observation.bodySite" />
            <short value="Observed body part" />
            <definition value="Indicates the site on the subject's body where the observation was made (i.e. the target site)." />
            <comment value="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](extension-body-site-instance.html)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.bodySite" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="BodySite" />
                </extension>
                <strength value="example" />
                <description value="Codes describing anatomical locations. May include laterality." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/body-site" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 123037004 |Body structure|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-20" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="targetSiteCode" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="718497002 |Inherent location|" />
            </mapping>
        </element>
        <element id="Observation.method">
            <path value="Observation.method" />
            <short value="How it was done" />
            <definition value="Indicates the mechanism used to perform the observation." />
            <comment value="Only used if not implicit in code for Observation.code." />
            <requirements value="In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.method" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationMethod" />
                </extension>
                <strength value="example" />
                <description value="Methods for simple observations." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-methods" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="OBX-17" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="methodCode" />
            </mapping>
        </element>
        <element id="Observation.specimen">
            <path value="Observation.specimen" />
            <short value="Specimen used for this observation" />
            <definition value="The specimen that was used when this observation was made." />
            <comment value="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)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.specimen" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen" />
            </type>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 123038009 |Specimen|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="SPM segment" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=SPC].specimen" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="704319004 |Inherent in|" />
            </mapping>
        </element>
        <element id="Observation.device">
            <path value="Observation.device" />
            <short value="(Measurement) Device" />
            <definition value="The device used to generate the observation data." />
            <comment value="An extension should be used if further typing of the device is needed.  Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.device" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceMetric" />
            </type>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 49062001 |Device|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-17 / PRT -10" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=DEV]" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="424226004 |Using device|" />
            </mapping>
        </element>
        <element id="Observation.referenceRange">
            <path value="Observation.referenceRange" />
            <short value="Provides guide for interpretation" />
            <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range." />
            <comment value="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." />
            <requirements value="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." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.referenceRange" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="BackboneElement" />
            </type>
            <constraint>
                <key value="ele-1" />
                <severity value="error" />
                <human value="All FHIR elements must have a @value or children" />
                <expression value="children().count() > id.count()" />
                <xpath value="@value|f:*|h:div" />
                <source value="Element" />
            </constraint>
            <constraint>
                <key value="obs-3" />
                <severity value="error" />
                <human value="Must have at least a low or a high or text" />
                <expression value="low.exists() or high.exists() or text.exists()" />
                <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))" />
            </constraint>
            <mapping>
                <identity value="v2" />
                <map value="OBX.7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.id">
            <path value="Observation.referenceRange.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.extension">
            <path value="Observation.referenceRange.extension" />
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.modifierExtension">
            <path value="Observation.referenceRange.modifierExtension" />
            <short value="Extensions that cannot be ignored" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <alias value="modifiers" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="BackboneElement.modifierExtension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <isModifier value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.low">
            <path value="Observation.referenceRange.low" />
            <short value="Low Range, if relevant" />
            <definition value="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)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.referenceRange.low" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Quantity" />
                <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
            </type>
            <condition value="obs-3" />
            <mapping>
                <identity value="v2" />
                <map value="OBX-7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value:IVL_PQ.low" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.high">
            <path value="Observation.referenceRange.high" />
            <short value="High Range, if relevant" />
            <definition value="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)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.referenceRange.high" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Quantity" />
                <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
            </type>
            <condition value="obs-3" />
            <mapping>
                <identity value="v2" />
                <map value="OBX-7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value:IVL_PQ.high" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.type">
            <path value="Observation.referenceRange.type" />
            <short value="Reference range qualifier" />
            <definition value="Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range." />
            <comment value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal range is assumed." />
            <requirements value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc,  - for proper interpretation." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.referenceRange.type" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationRangeMeaning" />
                </extension>
                <strength value="extensible" />
                <description value="Code for the meaning of a reference range." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/referencerange-meaning" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 260245000 |Findings values| OR  
< 365860008 |General clinical state finding| 
OR 
< 250171008 |Clinical history or observation findings| OR  
< 415229000 |Racial group| OR 
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-10" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="interpretationCode" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.appliesTo">
            <path value="Observation.referenceRange.appliesTo" />
            <short value="Reference range population" />
            <definition value="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." />
            <comment value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal population is assumed." />
            <requirements value="Need to be able to identify the target population for proper interpretation." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.referenceRange.appliesTo" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationRangeType" />
                </extension>
                <strength value="example" />
                <description value="Codes identifying the population the reference range applies to." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/referencerange-appliesto" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 260245000 |Findings values| OR  
< 365860008 |General clinical state finding| 
OR 
< 250171008 |Clinical history or observation findings| OR  
< 415229000 |Racial group| OR 
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-10" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="interpretationCode" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.age">
            <path value="Observation.referenceRange.age" />
            <short value="Applicable age range, if relevant" />
            <definition value="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 value="Some analytes vary greatly over age." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.referenceRange.age" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Range" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.text">
            <path value="Observation.referenceRange.text" />
            <short value="Text based reference range in an observation" />
            <definition value="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'." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.referenceRange.text" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="v2" />
                <map value="OBX-7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value:ST" />
            </mapping>
        </element>
        <element id="Observation.related">
            <path value="Observation.related" />
            <short value="Used when reporting vital signs panel components" />
            <definition value="Used when reporting vital signs panel components." />
            <comment value="For a discussion on the ways Observations can assembled in groups together see [Notes below](observation.html#4.20.4)." />
            <requirements value="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." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.related" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="BackboneElement" />
            </type>
            <constraint>
                <key value="ele-1" />
                <severity value="error" />
                <human value="All FHIR elements must have a @value or children" />
                <expression value="children().count() > id.count()" />
                <xpath value="@value|f:*|h:div" />
                <source value="Element" />
            </constraint>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="Relationships established by OBX-4 usage" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="outBoundRelationship" />
            </mapping>
        </element>
        <element id="Observation.related.id">
            <path value="Observation.related.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.related.extension">
            <path value="Observation.related.extension" />
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.related.modifierExtension">
            <path value="Observation.related.modifierExtension" />
            <short value="Extensions that cannot be ignored" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <alias value="modifiers" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="BackboneElement.modifierExtension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <isModifier value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.related.type">
            <path value="Observation.related.type" />
            <short value="has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by" />
            <definition value="A code specifying the kind of relationship that exists with the target resource." />
            <comment value="The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource." />
            <requirements value="A relationship type SHOULD be provided." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.related.type" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <fixedCode value="has-member" />
            <mustSupport value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationRelationshipType" />
                </extension>
                <strength value="required" />
                <description value="Codes specifying how two observations are related." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-relationshiptypes" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="N/A" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value=".typeCode" />
            </mapping>
        </element>
        <element id="Observation.related.target">
            <path value="Observation.related.target" />
            <short value="Resource that is related to this one" />
            <definition value="A reference to the observation or [QuestionnaireResponse](questionnaireresponse.html#) resource that is related to this observation." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.related.target" />
                <min value="1" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/vitalsigns" />
            </type>
            <mustSupport value="true" />
            <mapping>
                <identity value="rim" />
                <map value=".targetObservation" />
            </mapping>
        </element>
        <element id="Observation.component">
            <path value="Observation.component" />
            <short value="Used when reporting systolic and diastolic blood pressure." />
            <definition value="Used when reporting systolic and diastolic blood pressure." />
            <comment value="For a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below." />
            <requirements value="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." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.component" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="BackboneElement" />
            </type>
            <constraint>
                <key value="ele-1" />
                <severity value="error" />
                <human value="All FHIR elements must have a @value or children" />
                <expression value="children().count() > id.count()" />
                <xpath value="@value|f:*|h:div" />
                <source value="Element" />
            </constraint>
            <constraint>
                <key value="vs-3" />
                <severity value="error" />
                <human value="If there is no a value a data absent reason must be present" />
                <expression value="value.exists() or dataAbsentReason.exists()" />
                <xpath value="exists(f:*[starts-with(local-name(.), 'value')]) or exists(f:dataAbsentReason)" />
            </constraint>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="containment by OBX-4?" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="outBoundRelationship[typeCode=COMP]" />
            </mapping>
        </element>
        <element id="Observation.component.id">
            <path value="Observation.component.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.component.extension">
            <path value="Observation.component.extension" />
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.component.modifierExtension">
            <path value="Observation.component.modifierExtension" />
            <short value="Extensions that cannot be ignored" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <alias value="modifiers" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="BackboneElement.modifierExtension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <isModifier value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.component.code">
            <path value="Observation.component.code" />
            <short value="Type of component observation (code / type)" />
            <definition value="Describes what was observed. Sometimes this is called the observation "code"." />
            <requirements value="Knowing what kind of observation is being made is essential to understanding the observation." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.component.code" />
                <min value="1" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="VitalSigns" />
                </extension>
                <strength value="extensible" />
                <description value="This identifies the vital sign result type." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-vitalsignresult" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 363787002 |Observable entity| OR 
< 386053000 |Evaluation procedure|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-3" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="code" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="what" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity">
            <path value="Observation.component.valueQuantity" />
            <short value="Vital Sign Value recorded with UCUM" />
            <definition value="Vital Sign Value recorded with UCUM." />
            <comment value="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)." />
            <requirements value="9. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.component.value[x]" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Quantity" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="VitalSignsUnits" />
                </extension>
                <strength value="required" />
                <description value="Common UCUM units for recording Vital Signs" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/ucum-vitals-common" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="363714003 |Interprets| < 441742003 |Evaluation finding|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX.2, OBX.5, OBX.6" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="363714003 |Interprets|" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity.id">
            <path value="Observation.component.valueQuantity.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity.extension">
            <path value="Observation.component.valueQuantity.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <description value="Extensions are always sliced by (at least) url" />
                <rules value="open" />
            </slicing>
            <short value="Additional Content defined by implementations" />
            <definition value="May 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." />
            <comment value="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." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity.value">
            <path value="Observation.component.valueQuantity.value" />
            <short value="Numerical value (with implicit precision)" />
            <definition value="The value of the measured amount. The value includes an implicit precision in the presentation of the value." />
            <comment value="The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books)." />
            <requirements value="Precision is handled implicitly in almost all cases of measurement." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.value" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="decimal" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="SN.2  / CQ - N/A" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity.comparator">
            <path value="Observation.component.valueQuantity.comparator" />
            <short value="< | <= | >= | > - how to understand the value" />
            <definition value="How 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." />
            <comment value="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." />
            <requirements value="Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Quantity.comparator" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <meaningWhenMissing value="If there is no comparator, then there is no modification of the value" />
            <isModifier value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="QuantityComparator" />
                </extension>
                <strength value="required" />
                <description value="How the Quantity should be understood and represented." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/quantity-comparator" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="SN.1  / CQ.1" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="IVL properties" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity.unit">
            <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
                <valueBoolean value="true" />
            </extension>
            <path value="Observation.component.valueQuantity.unit" />
            <short value="Unit representation" />
            <definition value="A human-readable form of the unit." />
            <requirements value="There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.unit" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.unit" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity.system">
            <path value="Observation.component.valueQuantity.system" />
            <short value="System that defines coded unit form" />
            <definition value="The identification of the system that provides the coded form of the unit." />
            <requirements value="Need to know the system that defines the coded form of the unit." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.system" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="uri" />
            </type>
            <fixedUri value="http://unitsofmeasure.org" />
            <condition value="qty-3" />
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="CO.codeSystem, PQ.translation.codeSystem" />
            </mapping>
        </element>
        <element id="Observation.component.valueQuantity.code">
            <path value="Observation.component.valueQuantity.code" />
            <short value="Coded responses from the common UCUM units for vital signs value set." />
            <definition value="Coded responses from the common UCUM units for vital signs value set." />
            <comment value="The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency.  The context of use may additionally require a code from a particular system." />
            <requirements value="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." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.code" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.code, MO.currency, PQ.translation.code" />
            </mapping>
        </element>
        <element id="Observation.component.dataAbsentReason">
            <path value="Observation.component.dataAbsentReason" />
            <short value="Why the component result is missing" />
            <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing." />
            <comment value=""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." />
            <requirements value="For many results it is necessary to handle exceptional values in measurements." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.component.dataAbsentReason" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <condition value="obs-6" />
            <mustSupport value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="DAR" />
                </extension>
                <strength value="extensible" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="N/A" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value.nullFlavor" />
            </mapping>
        </element>
        <element id="Observation.component.interpretation">
            <path value="Observation.component.interpretation" />
            <short value="High, low, normal, etc." />
            <definition value="The 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." />
            <comment value="The component interpretation applies only to the individual component value.  For an overall interpretation all components together use thes Observation.interpretation element." />
            <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result." />
            <alias value="Abnormal Flag" />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.component.interpretation" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationInterpretation" />
                </extension>
                <strength value="extensible" />
                <description value="Codes identifying interpretations of observations." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-interpretation" />
                </valueSet>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="< 260245000 |Findings values|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-8" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="interpretationCode" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="363713009 |Has interpretation|" />
            </mapping>
        </element>
        <element id="Observation.component.referenceRange">
            <path value="Observation.component.referenceRange" />
            <short value="Provides guide for interpretation of component result" />
            <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range." />
            <comment value="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." />
            <requirements value="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." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.component.referenceRange" />
                <min value="0" />
                <max value="*" />
            </base>
            <contentReference value="#Observation.referenceRange" />
            <mapping>
                <identity value="v2" />
                <map value="OBX.7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]" />
            </mapping>
        </element>
    </snapshot>
    <differential>
        <element id="Observation">
            <path value="Observation" />
            <short value="FHIR Body Height Profile" />
            <definition value="This profile defines  how to represent Body Height observations in FHIR using a standard LOINC code and UCUM units of measure." />
            <min value="0" />
            <max value="*" />
        </element>
        <element id="Observation.code">
            <path value="Observation.code" />
            <short value="Body Height" />
            <definition value="Body Height." />
            <comment value="additional codes that translate or map to this code are allowed.  For example a more granular LOINC code or code that is used locally in a system." />
            <alias value="Test" />
            <alias value="Name" />
        </element>
        <element id="Observation.code.coding">
            <path value="Observation.code.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="code" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="Observation.code.coding:bodyheightcode">
            <path value="Observation.code.coding" />
            <sliceName value="BodyHeightCode" />
        </element>
        <element id="Observation.code.coding:bodyheightcode.system">
            <path value="Observation.code.coding.system" />
            <type>
                <code value="uri" />
            </type>
            <fixedUri value="http://loinc.org" />
        </element>
        <element id="Observation.code.coding:bodyheightcode.code">
            <path value="Observation.code.coding.code" />
            <type>
                <code value="code" />
            </type>
            <fixedCode value="8302-2" />
        </element>
        <element id="Observation.valueQuantity">
            <path value="Observation.valueQuantity" />
        </element>
        <element id="Observation.valueQuantity.code">
            <path value="Observation.valueQuantity.code" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="BodyLengthUnits" />
                </extension>
                <strength value="required" />
                <description value="Common UCUM units for Body Length measures such as Body Height and Head Circumference" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/ucum-bodylength" />
                </valueSet>
            </binding>
        </element>
    </differential>
</StructureDefinition>

US-Core

The US-Core implementation of FHIR is a national standard for the use of FHIR in the US. In the US, it is common to collect information about race. The specification includes an extension that can be used for this purpose. To be able to search on race as well, an additional search parameter is required. Here below is the implementation of the race search parameter in the US-Core specification.

SearchParameter 'USCoreRace'

Canonical URLhttp://hl7.org/fhir/us/core/SearchParameter/us-core-race
Published byUS Realm Steering Committee
StatusDraft (since 2016-12-22)

Returns patients with a race extension matching the specified code.

Contact Information

Other: http://www.healthit.gov/

Invocations

[base]/Patient?race=[system]|[value]

Details

ResourceCodeTypeFhirPathXpath (Normal)
Patientracetokenf:Patient/f:extension[@url='http://hl7.org/fhir/us/core/StructureDefinition/us-core-race']/f:extension[@url='ombCategory' or @url='detailed']


Exercise


In this exercise you will create some FHIRPath expressions to add constraints to your profiles and add an element path in a search parameter. Here below are a couple of links that you may find useful during this exercise:

    Case description
    Hospital X has started to build a FHIR server which they use to exchange data with patients and regional care providers. The hospital has already created profiles, but wants to add some more advanced constraints as well as some search parameters. The hospital asked you to help with the following tasks.
  • The format of the phone number and email should be validated
  • The status of a record should be set to inactive when a patient is deceased
  • The reason code should be present in a medication request when the priority is urgent
  • The hospital wants to be able to select patients based on their place of birth

Note that in the first two exercises, we work with profiles you created earlier in this course. If you didn't create these profiles yet, you can just start by creating new profiles in Forge. For the Patient profile at least add two slices for phone number and email address on the telecom element.

1. Constraining the Patient profile

  1. Open your Patient profile.
  2. Add an expression that checks if the value of the phone number is in a correct format (e.g. numbers only and a minimum length of 10).
  3. Add an expression that checks if the value of the email address is in a correct format (e.g. it should at least contain a @).
  4. Make sure both expressions are added in the correct element.
  5. Test your expressions by adding your profile to a Simplifier project as well as two instances of this profile: one with a phone number and email address in the correct format and one with a phone number and email address in a wrong format. You can either use SMART Fred or hand code the instances. Open the instances one by one and click the Validate button. If you need help on how to work with Simplifier, please visit our Get started with Simplifier module.

2. Constraining the MedicationRequest profile

  1. Open your MedicationRequest profile.
  2. Add an expression that checks if the reason code is present when the priority of the prescription is urgent.
  3. Make sure that you add the expression in the correct element.
  4. Test your expression by adding your profile to a Simplifier project as well as a correct instance and an incorrect instance. Open the instances one by one and click the Validate button.

3. Adding the place of birth search parameter

  1. Before adding a new search parameter, browse Simplifier and the search parameter registry to see if there's something you can reuse.
  2. Create an instance of the search parameter with SMART Fred or code it yourself.
  3. At least add all mandatory elements and the FHIRPath expression.

Feedback


We are always looking for ways to improve our products. The Profiling Academy was built using our own IG-editor in Simplifier. If you have any feedback on this module or on our Profiling Academy in general, please leave a comment in the Issue Tracker of the project.


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