Profile: cqf-observation

cqf-observation

Raw XML

<Profile xmlns="http://hl7.org/fhir">
  <id value="cqf-observation-cqf-observation"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
  </text>
  <url value="http://hl7.org/fhir/Profile/cqf-observation-cqf-observation"/>
  <name value="Clinical Quality Framework (CQF) Observation Profile"/>
  <publisher value="Health Level Seven, Inc. - CQI WG"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org/special/committees/CQI"/>
    </telecom>
  </contact>
  <description value="Observation"/>
  <status value="draft"/>
  <date value="2014-11-10"/>
  <type value="Observation"/>
  <base value="http://hl7.org/fhir/Profile/Observation"/>
  <snapshot>
    <element>
      <path value="Observation"/>
      <name value="cqf-observation"/>
      <short value="Observation"/>
      <definition value="A valid observation which has occurred, related to a patient."/>
      <comments 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."/>
      <requirements value="Observations are a key aspect of healthcare.  This resource is used to capture those that
       do not require more sophisticated mechanisms."/>
      <synonym value="Vital Signs"/>
      <synonym value="Measurement"/>
      <synonym value="Results"/>
      <synonym value="Tests"/>
      <min value="1"/>
      <max value="1"/>
      <constraint>
        <key value="obs-6"/>
        <name value="data absent reason"/>
        <severity value="error"/>
        <human value="Shall only be present if Observation.value[x] is not present"/>
        <xpath value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))"/>
      </constraint>
      <mapping>
        <identity value="v2"/>
        <map value="OBX"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Observation[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.id"/>
      <short value="Logical id of this artefact"/>
      <definition value="The logical id of the resource, as used in the url for the resoure. Once assigned, this
       value never changes."/>
      <comments 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. Bundles always have an id, though it is usually a generated
       UUID."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
    </element>
    <element>
      <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"/>
      <type>
        <code value="Meta"/>
      </type>
    </element>
    <element>
      <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."/>
      <comments 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 as much as possible."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
    </element>
    <element>
      <path value="Observation.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comments 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"/>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <name value="Language"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="A human language"/>
        <referenceUri value="http://tools.ietf.org/html/bcp47"/>
      </binding>
    </element>
    <element>
      <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 &quot;clinically
       safe&quot; for a human to just read the narrative. Resource definitions may define what
       content should be represented in the narrative to ensure clinical safety."/>
      <comments value="Contained resources do not have narrative. Resources that are not contained SHOULD have
       a narrative."/>
      <synonym value="narrative"/>
      <synonym value="html"/>
      <synonym value="xhtml"/>
      <synonym value="display"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Narrative"/>
      </type>
      <condition value="dom-1"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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."/>
      <synonym value="inline resources"/>
      <synonym value="anonymous resources"/>
      <synonym value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Resource"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.code"/>
      <short value="Type of observation (code / type)"/>
      <definition value="Describes what was observed. Sometimes this is called the observation &quot;code&quot;."/>
      <requirements value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <name value="ObservationType"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="Codes identifying types of simple observations"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/observation-codes"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3-observation identifier"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.value[x]"/>
      <short value="Actual result"/>
      <definition value="The information determined as a result of making the observation, if the information has
       a simple value."/>
      <comments value="Normally, an observation will have either a value or a set of related observations. A
       few observations (e.g. apgar store) may have both a value and related observations (for
       apgar, 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 &lt;http://hl7.org/fhir/v2/vs/0136&gt;
       (These &quot;yes/no&quot; concepts can be mapped to the display name &quot;true/false&quot;
       or other mutually exclusive terms that may be needed&quot;).  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 &quot;'value' + the type name&quot; with a capital on the first letter of the type)."/>
      <requirements value="An observation exists to have a value, though it may not if it is in error, or it represents
       a group of observations."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Quantity"/>
      </type>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="Attachment"/>
      </type>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <type>
        <code value="SampledData"/>
      </type>
      <type>
        <code value="string"/>
      </type>
      <type>
        <code value="time"/>
      </type>
      <mustSupport value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.2, OBX.5, OBX.6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.dataAbsentReason"/>
      <short value="unknown | asked | temp | notasked +"/>
      <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing."/>
      <comments value="&quot;Null&quot; 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  &quot;detected&quot;,
       &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;.   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 &quot;error&quot; 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="0"/>
      <type>
        <code value="code"/>
      </type>
      <exampleCode value="unknown"/>
      <condition value="obs-6"/>
      <mustSupport value="false"/>
      <binding>
        <name value="DataAbsentReason"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="Used to specify why the normally expected content of the data element is missing"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/data-absent-reason"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.interpretation"/>
      <short value="High, low, normal, etc."/>
      <definition value="The assessment made based on the result of the observation."/>
      <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully
       understand the significance of a result."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="false"/>
      <binding>
        <name value="ObservationInterpretation"/>
        <isExtensible value="true"/>
        <conformance value="preferred"/>
        <description value="Codes identifying interpretations of observations"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/observation-interpretation"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-8-interpretation codes"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.comments"/>
      <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"/>
      <type>
        <code value="string"/>
      </type>
      <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=&quot;annotation&quot;].value"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.applies[x]"/>
      <short value="Physiologically Relevant time/time-period for observation"/>
      <definition value="The time or time-period the observed value is asserted as being true. For biological subjects
       - e.g. human patients - this is usually called the &quot;physiologically relevant time&quot;.
       This is usually either the time of the procedure or of specimen collection, but very often
       the source of the date/time is not known, only the date/time itself."/>
      <comments 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."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <mustSupport value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-14-date/time of the observation, and/or OBX-19 after v2.4  (depends on who observation
         made)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="effectiveTime"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.issued"/>
      <short value="Date/Time this was made available"/>
      <definition value="The date and time this observation was made available."/>
      <comments value="Updated when the result is updated."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="instant"/>
      </type>
      <mustSupport value="false"/>
      <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>
    </element>
    <element>
      <extension url="http://hl7.org/fhir/ExtensionDefinition/profile-display-hint">
        <valueString value="default: final"/>
      </extension>
      <path value="Observation.status"/>
      <short value="final | amended"/>
      <definition value="final | amended."/>
      <requirements value="Need to track the status of individual results - some results are finalised before the
       whole report is finalised."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <binding>
        <name value="CQFObservationStatus"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="Codes providing the status of a CQF observation"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/cqf-observation-status"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-11-observation result status"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct
         event with a type of &quot;revise&quot;"/>
      </mapping>
    </element>
    <element>
      <extension url="http://hl7.org/fhir/ExtensionDefinition/profile-display-hint">
        <valueString value="default: ok"/>
      </extension>
      <path value="Observation.reliability"/>
      <short value="ok | ongoing | early"/>
      <definition value="ok | ongoing | early."/>
      <comments value="Note that in most contexts, unreliable results are not recorded, deleted, or otherwise
       excluded, but it's not always possible to exclude them from the record.  If the reliability
       indicator is present, interpreters of a result, whether human or machine, should always
       either be aware of the status or prevented from using the observation without being unaware
       that the reliability is not &quot;ok&quot;."/>
      <requirements value="Not all results are completely reliable, and some are still reported anyway."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <binding>
        <name value="CQFObservationReliability"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="Codes provide reliability of a CQF observation"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/cqf-observation-reliability"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="Maybe OBX.8/OBX.9"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="uncertaintyCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.bodySiteCodeableConcept"/>
      <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)."/>
      <comments value="Only used if not implicit in code found in Observation.code."/>
      <requirements value="Knowing where the observation is made is important for tracking if multiple sites are
       possible."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <name value="BodySite"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="Codes describing anatomical locations. May include laterality"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/body-site"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-20-observation site"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="targetSiteCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.method"/>
      <short value="How it was done"/>
      <definition value="Indicates the mechanism used to perform the observation."/>
      <comments value="Only used if not implicit in code for Observation.code."/>
      <requirements value="In some cases, method can impact results and is thus for determining whether results can
       be compared or determining significance of results."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <name value="ObservationMethod"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="Methods for simple observations"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/observation-methods"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-17-observation method"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="methodCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.identifier"/>
      <short value="Unique Id for this particular observation"/>
      <definition value="A unique identifier for the simple observation."/>
      <requirements value="Allows observations to be distinguished and referenced."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Identifier"/>
      </type>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.21"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="id"/>
      </mapping>
    </element>
    <element>
      <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, other observer
       (for example a relative or EMT), or any observation made about the subject."/>
      <comments value="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 (http://hl7.org/fhir/ExtensionDefinition/indirectTarget) can  be used."/>
      <requirements value="Observations have no value if you don't know who or what they're about."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Group"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Device"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Location"/>
      </type>
      <mustSupport value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="PID-3-patient ID list"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SBJ]"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.specimen"/>
      <short value="Specimen used for this observation"/>
      <definition value="The specimen that was used when this observation was made."/>
      <comments value="Observations are not made on specimens themselves; they are made on a subject, but usually
       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 are often
       used in contexts that track the specimen explicitly (e.g. Diagnostic Report)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Specimen"/>
      </type>
      <mustSupport value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SPC].specimen"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.performer"/>
      <short value="Who did the observation"/>
      <definition value="Who was responsible for asserting the observed value as &quot;true&quot;."/>
      <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="*"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Practitioner"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Organization"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/RelatedPerson"/>
      </type>
      <mustSupport value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.15 / (Practitioner)  OBX-16-responsible observer,  PRT-5-participation person:PRT-4-participatio
        n='RO' /  (Device)  OBX-18-equipment instance identifier , PRT-10-participation device:PRT-4-particip
        ation='EQUIP' / (Organization)  OBX-23-performing organization name,  PRT-8-participation
         organization:PRT-4-participation='PO'"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=PRF]"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.device"/>
      <short value="(Measurement) Device"/>
      <definition value="The device used to generate the observation data."/>
      <comments 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 extension or through
       the Observation.related element."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Device"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/DeviceMetric"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.encounter"/>
      <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."/>
      <requirements value="For some observations it may be important to know the link between an observation and
       a particular encounter."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Encounter"/>
      </type>
      <mustSupport value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="PV1"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Encounter[moodCode=EVN]"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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 &quot;normal&quot; 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="*"/>
      <type>
        <code value="string"/>
      </type>
      <constraint>
        <key value="obs-3"/>
        <name value="reference range"/>
        <severity value="error"/>
        <human value="Must have at least a low or a high or text"/>
        <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))"/>
      </constraint>
      <mustSupport value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
    <element>
      <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 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."/>
      <comments 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."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
    </element>
    <element>
      <path value="Observation.referenceRange.value"/>
      <representation value="xmlAttr"/>
      <short value="Primitive value for string"/>
      <definition value="The actual value"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="xsd:string"/>
      </type>
    </element>
    <element>
      <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)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <synonym value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.low"/>
      <short value="Low Range, if relevant"/>
      <definition value="The value of the low bound of the reference range. If this element is omitted, the low
       bound of the reference range is assumed to be meaningless. (e.g. reference range is &lt;2.3)
        If the low.comparator element is missing, it is assumed to be '&gt;'."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Quantity"/>
      </type>
      <condition value="obs-3"/>
      <condition value="obs-4"/>
      <constraint>
        <key value="obs-4"/>
        <name value="low range comparators"/>
        <severity value="error"/>
        <human value="Low range comparators can only be '&gt;' or '&gt;=' or empty"/>
        <xpath value="not(exists(f:comparator)) or boolean(f:comparator/@value = '&lt;') or boolean(f:comparator/@value
         = '&lt;=')"/>
      </constraint>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7-references range"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.low"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.high"/>
      <short value="High Range, if relevant"/>
      <definition value="The value of the high bound of the reference range. If this element is omitted, the high
       bound of the reference range is assumed to be meaningless. (e.g. reference range is &gt;
       5)  If the low.comparator element is missing , it is assumed to be '&lt;'."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Quantity"/>
      </type>
      <condition value="obs-3"/>
      <condition value="obs-5"/>
      <constraint>
        <key value="obs-5"/>
        <name value="high range comparators"/>
        <severity value="error"/>
        <human value="High range comparators can only be '&lt;' or '&lt;=' or empty"/>
        <xpath value="not(exists(f:comparator)) or boolean(f:comparator/@value = '&gt;') or boolean(f:comparator/@value
         = '&gt;=')"/>
      </constraint>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7-references range"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.high"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.meaning"/>
      <short value="Indicates the meaning/use of this range of this range"/>
      <definition value="Code for the meaning of the reference range."/>
      <comments value="This SHOULD be populated if there is more than one range."/>
      <requirements value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic,
       or perhaps what state this reference range applies to (i.e. age, hormonal cycles, etc.)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <binding>
        <name value="ObservationRangeMeaning"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="Code for the meaning of a reference range"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/referencerange-meaning"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10-nature of abnormal test?"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element>
      <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"/>
      <type>
        <code value="Range"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/>
      </mapping>
    </element>
    <element>
      <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 &quot;Negative&quot
      ; or a list or table of 'normals'."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element>
      <path value="Observation.related"/>
      <short value="Observations related to this observation"/>
      <definition value="Related observations - either components, or previous observations, or statements of derivation."/>
      <comments value="Normally, an observation will have either a value or a set of related observations. A
       few observations (e.g. apgar store) may have both a value and related observations (for
       apgar, the observations from which the measure is derived)."/>
      <requirements value="Some observations have important relationships to other observations (e.g Blood Pressure
       = systolic + diastolic), or are derived from other observations (e.g. calculated apgar
       score)."/>
      <min value="0"/>
      <max value="*"/>
      <mustSupport 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>
      <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)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <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."/>
      <comments 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."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <synonym value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related.type"/>
      <short value="has-component | 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 observation."/>
      <comments value="A relationship type SHOULD be provided. If the relationship type is &quot;COMP&quot; (composed),
       then the observation should not be displayed/interpreted in the absence of the related
       observations."/>
      <requirements value="May need to indicate whether this observation is composed of others, or merely derived
       from them."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <name value="ObservationRelationshipType"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="Codes specifying how two observations are related"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/observation-relationshiptypes"/>
        </referenceReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".typeCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related.target"/>
      <short value="Observation that is related to this one"/>
      <definition value="A reference to the observation that is related to this observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Observation"/>
      </type>
      <mustSupport value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element>
      <path value="Observation"/>
      <name value="cqf-observation"/>
      <short value="Observation"/>
      <definition value="A valid observation which has occurred, related to a patient."/>
      <synonym value="Vital Signs"/>
      <synonym value="Measurement"/>
      <synonym value="Results"/>
      <synonym value="Tests"/>
      <min value="1"/>
      <max value="1"/>
    </element>
    <element>
      <path value="Observation.code"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.value[x]"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Quantity"/>
      </type>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="Attachment"/>
      </type>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <type>
        <code value="SampledData"/>
      </type>
      <type>
        <code value="string"/>
      </type>
      <type>
        <code value="time"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.dataAbsentReason"/>
      <min value="0"/>
      <max value="0"/>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.interpretation"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.applies[x]"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.issued"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="instant"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.status"/>
      <short value="final | amended"/>
      <definition value="final | amended."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="false"/>
      <binding>
        <name value="CQFObservationStatus"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="Codes providing the status of a CQF observation"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/cqf-observation-status"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="Observation.reliability"/>
      <short value="ok | ongoing | early"/>
      <definition value="ok | ongoing | early."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <name value="CQFObservationReliability"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="Codes provide reliability of a CQF observation"/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/cqf-observation-reliability"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="Observation.bodySite[x]"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.method"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.subject"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Group"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Device"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Location"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.specimen"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Specimen"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.performer"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Practitioner"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Organization"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/RelatedPerson"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.device"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Device"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/DeviceMetric"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.encounter"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Encounter"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.referenceRange"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="string"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.referenceRange.low"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Quantity"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.referenceRange.high"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Quantity"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.referenceRange.meaning"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.referenceRange.age"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Range"/>
      </type>
      <mustSupport value="false"/>
    </element>
    <element>
      <path value="Observation.related"/>
      <min value="0"/>
      <max value="*"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.related.type"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="Observation.related.target"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Observation"/>
      </type>
      <mustSupport value="true"/>
    </element>
  </differential>
</Profile>