2nd DSTU Draft For Comment
This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
Source for Dictionary based Profilenull
{
"resourceType": "Profile",
"id": "hspc-QuantitativeLab-dataelements-LactateSCncPtBldAQnLabObs",
"url": "http://hl7.org/fhir/Profile/LactateSCncPtBldAQnLabObs",
"name": "HSPC Standard Quantitative Lab: Lactate",
"publisher": "HSPC",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "http://healthcaresoa.org"
}
]
}
],
"description": "??",
"status": "draft",
"date": "2015-02-18",
"type": "Observation",
"base": "http://hl7.org/fhir/Profile/observation-hspc-standardlabobs-quantitative-stdqty",
"snapshot": {
"element": [
{
"path": "Observation",
"name": "stdqty",
"short": "Measurements and simple assertions",
"definition": "Measurements and simple assertions made about a patient, device or other subject.",
"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.",
"requirements": "Observations are a key aspect of healthcare. This resource is used to capture those that do not require more sophisticated mechanisms.",
"synonym": [
"Vital Signs",
"Measurement",
"Results",
"Tests"
],
"min": 1,
"max": "1",
"constraint": [
{
"key": "obs-6",
"name": "data absent reason",
"severity": "error",
"human": "Shall only be present if Observation.value[x] is not present",
"xpath": "not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))"
},
{
"key": "inv-1",
"name": "value or dataAbsentReason",
"severity": "error",
"human": "Must have either a value or a dataAbsentReason but not both",
"xpath": "(f:value or f:dataAbsentReason) and (not(f:value and f:dataAbsentReason))"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX"
},
{
"identity": "rim",
"map": "Observation[classCode=OBS, moodCode=EVN]"
}
]
},
{
"path": "Observation.id",
"short": "Logical id of this artefact",
"definition": "The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.",
"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.",
"min": 0,
"max": "1",
"type": [
{
"code": "id"
}
]
},
{
"path": "Observation.meta",
"short": "Metadata about the resource",
"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.",
"min": 0,
"max": "1",
"type": [
{
"code": "Meta"
}
]
},
{
"path": "Observation.implicitRules",
"short": "A set of rules under which this content was created",
"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.",
"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.",
"min": 0,
"max": "1",
"type": [
{
"code": "uri"
}
],
"isModifier": true
},
{
"path": "Observation.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"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\n\nNot 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": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"binding": {
"name": "Language",
"isExtensible": false,
"conformance": "required",
"description": "A human language",
"referenceUri": "http://tools.ietf.org/html/bcp47"
}
},
{
"path": "Observation.text",
"short": "Text summary of the resource, for human interpretation",
"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.",
"comments": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.",
"synonym": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"type": [
{
"code": "Narrative"
}
],
"condition": [
"dom-1"
],
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"path": "Observation.contained",
"short": "Contained, inline Resources",
"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.",
"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.",
"synonym": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Resource"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.extension",
"slicing": {
"discriminator": [
"url"
],
"ordered": false,
"rules": "open"
},
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.extension",
"name": "reportingPriority",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "1",
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/ExtensionDefinition/hspc-ReportingPriority"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.extension",
"name": "deltaFlag",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "1",
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/ExtensionDefinition/hspc-DeltaFlag"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.extension",
"name": "verified",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "1",
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/ExtensionDefinition/hspc-Verified"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.extension",
"name": "updated",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "1",
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/ExtensionDefinition/hspc-Updated"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.extension",
"name": "indirectTarget",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "1",
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/ExtensionDefinition/indirectTarget"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.modifierExtension",
"short": "Extensions that cannot be ignored",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.code",
"short": "Type of observation (code / type)",
"definition": "Describes what was observed. Sometimes this is called the observation \"code\".",
"requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
"min": 1,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"fixedCodeableConcept": {
"coding": [
{
"system": "http://loinc.org",
"code": "2518-9"
}
]
},
"binding": {
"name": "HSPC-Quantitative-Observations",
"isExtensible": true,
"conformance": "preferred",
"description": "Standard LOINC codes",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/hspc-QuantitativeLabCodes"
}
},
"mapping": [
{
"identity": "v2",
"map": "OBX-3-observation identifier"
},
{
"identity": "rim",
"map": "code"
},
{
"identity": "cdl.key",
"map": "StandardLabObs_KEY_VALUESET_ECID"
}
]
},
{
"path": "Observation.valueQuantity",
"short": "Actual result",
"definition": "The information determined as a result of making the observation, if the information has a simple value.",
"comments": "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 <http://hl7.org/fhir/v2/vs/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": "An observation exists to have a value, though it may not if it is in error, or it represents a group of observations.",
"min": 0,
"max": "1",
"type": [
{
"code": "Quantity"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX.2, OBX.5, OBX.6"
},
{
"identity": "rim",
"map": "value"
}
]
},
{
"path": "Observation.valueQuantity.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references).",
"min": 0,
"max": "1",
"type": [
{
"code": "id"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "Observation.valueQuantity.extension",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "Observation.valueQuantity.value",
"short": "Numerical value (with implicit precision)",
"definition": "The value of the measured amount. The value includes an implicit precision in the presentation of the value.",
"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).",
"requirements": "Precision is handled implicitly in almost all cases of measurement.",
"min": 1,
"max": "1",
"type": [
{
"code": "decimal"
}
],
"mapping": [
{
"identity": "v2",
"map": "SN.2 / CQ - N/A"
},
{
"identity": "rim",
"map": "PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value"
}
]
},
{
"path": "Observation.valueQuantity.comparator",
"short": "< | <= | >= | > - how to understand the value",
"definition": "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.",
"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.",
"requirements": "Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"isModifier": true,
"binding": {
"name": "QuantityComparator",
"isExtensible": false,
"conformance": "required",
"description": "How the Quantity should be understood and represented",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/quantity-comparator"
}
},
"mapping": [
{
"identity": "v2",
"map": "SN.1 / CQ.1"
},
{
"identity": "rim",
"map": "IVL properties"
}
]
},
{
"path": "Observation.valueQuantity.units",
"short": "Unit representation",
"definition": "A human-readable form of the units.",
"requirements": "There are many representations for units and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.",
"min": 1,
"max": "1",
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "v2",
"map": "(see OBX.6 etc) / CQ.2"
},
{
"identity": "rim",
"map": "PQ.unit"
}
]
},
{
"path": "Observation.valueQuantity.system",
"short": "System that defines coded unit form",
"definition": "The identification of the system that provides the coded form of the unit.",
"requirements": "Need to know the system that defines the coded form of the unit.",
"min": 1,
"max": "1",
"type": [
{
"code": "uri"
}
],
"fixedUri": "http://unitsofmeasure.org",
"condition": [
"qty-3"
],
"mapping": [
{
"identity": "v2",
"map": "(see OBX.6 etc) / CQ.2"
},
{
"identity": "rim",
"map": "CO.codeSystem, PQ.translation.codeSystem"
}
]
},
{
"path": "Observation.valueQuantity.code",
"short": "Coded form of the unit",
"definition": "A computer processable form of the units in some unit representation system.",
"comments": "The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency.\n\nThe context of use may additionally require a code from a particular system.",
"requirements": "Need a computable form of the units that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.",
"min": 1,
"max": "1",
"type": [
{
"code": "code"
}
],
"fixedCode": "mmol/L",
"mapping": [
{
"identity": "v2",
"map": "(see OBX.6 etc) / CQ.2"
},
{
"identity": "rim",
"map": "PQ.code, MO.currency, PQ.translation.code"
}
]
},
{
"path": "Observation.dataAbsentReason",
"short": "unknown | asked | temp | notasked +",
"definition": "Provides a reason why the expected value in the element Observation.value[x] is missing.",
"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.",
"requirements": "For many results it is necessary to handle exceptional values in measurements.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"exampleCode": "unknown",
"condition": [
"obs-6"
],
"binding": {
"name": "DataAbsentReason",
"isExtensible": false,
"conformance": "required",
"description": "Used to specify why the normally expected content of the data element is missing",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/data-absent-reason"
}
},
"mapping": [
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": "value.nullFlavor"
}
]
},
{
"path": "Observation.interpretation",
"short": "High, low, normal, etc.",
"definition": "The assessment made based on the result of the observation.",
"requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"name": "CEM_AbnormalInterpretation",
"isExtensible": true,
"conformance": "preferred",
"description": "See CEM (todo)",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/hspc-Abnormal"
}
},
"mapping": [
{
"identity": "v2",
"map": "OBX-8-interpretation codes"
},
{
"identity": "rim",
"map": "interpretationCode"
},
{
"identity": "cdl.key",
"map": "AbnormalInterpretation_KEY_ECID,OrdinalInterpretation_KEY_ECID"
}
]
},
{
"path": "Observation.comments",
"short": "Comments about result",
"definition": "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": "Need to be able to provide free text additional information.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "v2",
"map": "NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)"
},
{
"identity": "rim",
"map": "subjectOf.observationEvent[code=\"annotation\"].value"
},
{
"identity": "cdl.key",
"map": "Comment_KEY_ECID"
}
]
},
{
"path": "Observation.applies[x]",
"short": "Physiologically Relevant time/time-period for observation",
"definition": "The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the \"physiologically relevant time\". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.",
"comments": "At least a date should be present unless this observation is a historical report.",
"requirements": "Knowing when an observation was deemed true is important to its relevance as well as determining trends.",
"min": 0,
"max": "0",
"type": [
{
"code": "dateTime"
},
{
"code": "Period"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX-14-date/time of the observation, and/or OBX-19 after v2.4 (depends on who observation made)"
},
{
"identity": "rim",
"map": "effectiveTime"
},
{
"identity": "cdl.key",
"map": "Resulted_ECID"
}
]
},
{
"path": "Observation.issued",
"short": "Date/Time this was made available",
"definition": "The date and time this observation was made available.",
"comments": "Updated when the result is updated.",
"min": 0,
"max": "1",
"type": [
{
"code": "instant"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)"
},
{
"identity": "rim",
"map": "participation[typeCode=AUT].time"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/ExtensionDefinition/profile-display-hint",
"valueString": "default: final"
}
],
"path": "Observation.status",
"short": "registered | preliminary | final | amended +",
"definition": "The status of the result value.",
"requirements": "Need to track the status of individual results - some results are finalised before the whole report is finalised.",
"min": 1,
"max": "1",
"type": [
{
"code": "code"
}
],
"isModifier": true,
"binding": {
"name": "ObservationStatus",
"isExtensible": false,
"conformance": "required",
"description": "Codes providing the status of an observation",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/observation-status"
}
},
"mapping": [
{
"identity": "v2",
"map": "OBX-11-observation result status"
},
{
"identity": "rim",
"map": "status\n\nAmended & Final are differentiated by whether it is the subject of a ControlAct event with a type of \"revise\""
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/ExtensionDefinition/profile-display-hint",
"valueString": "default: ok"
}
],
"path": "Observation.reliability",
"short": "ok | ongoing | early | questionable | calibrating | error +",
"definition": "An estimate of the degree to which quality issues have impacted on the value reported.",
"comments": "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 \"ok\".",
"requirements": "Not all results are completely reliable, and some are still reported anyway.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"fixedCode": "ok",
"isModifier": true,
"binding": {
"name": "ObservationReliability",
"isExtensible": false,
"conformance": "required",
"description": "Codes that provide an estimate of the degree to which quality issues have impacted on the value of an observation",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/observation-reliability"
}
},
"mapping": [
{
"identity": "v2",
"map": "Maybe OBX.8/OBX.9"
},
{
"identity": "rim",
"map": "uncertaintyCode"
}
]
},
{
"path": "Observation.bodySite[x]",
"short": "Observed body part",
"definition": "Indicates the site on the subject's body where the observation was made ( i.e. the target site).",
"comments": "Only used if not implicit in code found in Observation.code.",
"requirements": "Knowing where the observation is made is important for tracking if multiple sites are possible.",
"min": 0,
"max": "0",
"type": [
{
"code": "CodeableConcept"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/BodySite"
}
],
"binding": {
"name": "BodySite",
"isExtensible": true,
"conformance": "example",
"description": "Codes describing anatomical locations. May include laterality",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/body-site"
}
},
"mapping": [
{
"identity": "v2",
"map": "OBX-20-observation site"
},
{
"identity": "rim",
"map": "targetSiteCode"
}
]
},
{
"path": "Observation.method",
"short": "How it was done",
"definition": "Indicates the mechanism used to perform the observation.",
"comments": "Only used if not implicit in code for Observation.code.",
"requirements": "In some cases, method can impact results and is thus for determining whether results can be compared or determining significance of results.",
"min": 0,
"max": "0",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"name": "ObservationMethod",
"isExtensible": true,
"conformance": "example",
"description": "Methods for simple observations",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/observation-methods"
}
},
"mapping": [
{
"identity": "v2",
"map": "OBX-17-observation method"
},
{
"identity": "rim",
"map": "methodCode"
}
]
},
{
"path": "Observation.identifier",
"short": "Unique Id for this particular observation",
"definition": "A unique identifier for the simple observation.",
"requirements": "Allows observations to be distinguished and referenced.",
"min": 0,
"max": "0",
"type": [
{
"code": "Identifier"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX.21"
},
{
"identity": "rim",
"map": "id"
}
]
},
{
"path": "Observation.subject",
"short": "Who and/or what this is about",
"definition": "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,\nother observer (for example a relative or EMT), or any observation made about the subject.",
"comments": "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": "Observations have no value if you don't know who or what they're about.",
"min": 1,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Patient"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Group"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Device"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Location"
}
],
"mapping": [
{
"identity": "v2",
"map": "PID-3-patient ID list"
},
{
"identity": "rim",
"map": "participation[typeCode=SBJ]"
},
{
"identity": "cdl.key",
"map": "Subject_KEY_ECID"
}
]
},
{
"path": "Observation.specimen",
"short": "Specimen used for this observation",
"definition": "The specimen that was used when this observation was made.",
"comments": "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": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/hspc-Specimen",
"aggregation": [
"contained"
]
}
],
"mapping": [
{
"identity": "rim",
"map": "participation[typeCode=SPC].specimen"
}
]
},
{
"path": "Observation.performer",
"slicing": {
"discriminator": [
"performer.type"
],
"ordered": true,
"rules": "closed"
},
"short": "Who did the observation",
"definition": "Who was responsible for asserting the observed value as \"true\".",
"requirements": "May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.",
"min": 0,
"max": "*",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Practitioner"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Organization"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Patient"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/RelatedPerson"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX.15 / (Practitioner) OBX-16-responsible observer, PRT-5-participation person:PRT-4-participation='RO' / \n(Device) OBX-18-equipment instance identifier , PRT-10-participation device:PRT-4-participation='EQUIP' / (Organization) OBX-23-performing organization name, PRT-8-participation organization:PRT-4-participation='PO'"
},
{
"identity": "rim",
"map": "participation[typeCode=PRF]"
}
]
},
{
"path": "Observation.performer",
"name": "person",
"short": "the individual with the primary responsibility for the procedure or action being taken",
"definition": "the individual with the primary responsibility for the procedure or action being taken.",
"requirements": "May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.",
"min": 0,
"max": "*",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/hspc-ResponsibleObserver"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX.15 / (Practitioner) OBX-16-responsible observer, PRT-5-participation person:PRT-4-participation='RO' / \n(Device) OBX-18-equipment instance identifier , PRT-10-participation device:PRT-4-participation='EQUIP' / (Organization) OBX-23-performing organization name, PRT-8-participation organization:PRT-4-participation='PO'"
},
{
"identity": "rim",
"map": "participation[typeCode=PRF]"
},
{
"identity": "cdl.key",
"map": "ResponsibleObserver_KEY_ECID"
}
]
},
{
"path": "Observation.performer",
"name": "lab",
"short": "name and address of the laboratory that performs the test",
"definition": "documents the name and address of the laboratory that performs the test. This is a CLIA required item to be printed on the report, CLIA requires the name of the laboratory, city and state of the laboratory.",
"requirements": "May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/hspc-PerformingLaboratory"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX.15 / (Practitioner) OBX-16-responsible observer, PRT-5-participation person:PRT-4-participation='RO' / \n(Device) OBX-18-equipment instance identifier , PRT-10-participation device:PRT-4-participation='EQUIP' / (Organization) OBX-23-performing organization name, PRT-8-participation organization:PRT-4-participation='PO'"
},
{
"identity": "rim",
"map": "participation[typeCode=PRF]"
},
{
"identity": "cdl.key",
"map": "PerformingLaboratory_KEY_ECID"
}
]
},
{
"path": "Observation.device",
"short": "(Measurement) Device",
"definition": "The device used to generate the observation data.",
"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 extension or through the Observation.related element.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Device"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/DeviceMetric"
}
]
},
{
"path": "Observation.encounter",
"short": "Healthcare event during which this observation is made",
"definition": "The healthcare event ( e.g. a patient and healthcare provider interaction ) during which this observation is made.",
"requirements": "For some observations it may be important to know the link between an observation and a particular encounter.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Encounter"
}
],
"mapping": [
{
"identity": "v2",
"map": "PV1"
},
{
"identity": "rim",
"map": "Encounter[moodCode=EVN]"
}
]
},
{
"path": "Observation.referenceRange",
"short": "Provides guide for interpretation",
"definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
"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.",
"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.",
"min": 1,
"max": "1",
"constraint": [
{
"key": "obs-3",
"name": "reference range",
"severity": "error",
"human": "Must have at least a low or a high or text",
"xpath": "(exists(f:low) or exists(f:high)or exists(f:text))"
}
],
"mapping": [
{
"identity": "rim",
"map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
}
]
},
{
"path": "Observation.referenceRange.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references).",
"min": 0,
"max": "1",
"type": [
{
"code": "id"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "Observation.referenceRange.extension",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "Observation.referenceRange.modifierExtension",
"short": "Extensions that cannot be ignored",
"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.",
"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.",
"synonym": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.referenceRange.low",
"short": "Low Range, if relevant",
"definition": "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 <2.3) If the low.comparator element is missing, it is assumed to be '>'.",
"min": 0,
"max": "0",
"type": [
{
"code": "Quantity"
}
],
"condition": [
"obs-3",
"obs-4"
],
"constraint": [
{
"key": "obs-4",
"name": "low range comparators",
"severity": "error",
"human": "Low range comparators can only be '>' or '>=' or empty",
"xpath": "not(exists(f:comparator)) or boolean(f:comparator/@value = '<') or boolean(f:comparator/@value = '<=')"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX-7-references range"
},
{
"identity": "rim",
"map": "value:IVL_PQ.low"
}
]
},
{
"path": "Observation.referenceRange.high",
"short": "High Range, if relevant",
"definition": "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 > 5) If the low.comparator element is missing , it is assumed to be '<'.",
"min": 0,
"max": "0",
"type": [
{
"code": "Quantity"
}
],
"condition": [
"obs-3",
"obs-5"
],
"constraint": [
{
"key": "obs-5",
"name": "high range comparators",
"severity": "error",
"human": "High range comparators can only be '<' or '<=' or empty",
"xpath": "not(exists(f:comparator)) or boolean(f:comparator/@value = '>') or boolean(f:comparator/@value = '>=')"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX-7-references range"
},
{
"identity": "rim",
"map": "value:IVL_PQ.high"
}
]
},
{
"path": "Observation.referenceRange.meaning",
"short": "Indicates the meaning/use of this range of this range",
"definition": "Code for the meaning of the reference range.",
"comments": "This SHOULD be populated if there is more than one range.",
"requirements": "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": 0,
"max": "0",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"name": "ObservationRangeMeaning",
"isExtensible": true,
"conformance": "example",
"description": "Code for the meaning of a reference range",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/referencerange-meaning"
}
},
"mapping": [
{
"identity": "v2",
"map": "OBX-10-nature of abnormal test?"
},
{
"identity": "rim",
"map": "interpretationCode"
}
]
},
{
"path": "Observation.referenceRange.age",
"short": "Applicable age range, if relevant",
"definition": "The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.",
"requirements": "Some analytes vary greatly over age.",
"min": 0,
"max": "0",
"type": [
{
"code": "Range"
}
],
"mapping": [
{
"identity": "rim",
"map": "outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=\"age\"].value"
}
]
},
{
"path": "Observation.referenceRange.text",
"short": "Text based reference range in an observation",
"definition": "Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of \"Negative\" or a list or table of 'normals'.",
"min": 1,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"path": "Observation.related",
"short": "Observations related to this observation",
"definition": "Related observations - either components, or previous observations, or statements of derivation.",
"comments": "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": "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": 0,
"max": "0",
"mapping": [
{
"identity": "v2",
"map": "Relationships established by OBX-4 usage"
},
{
"identity": "rim",
"map": "outBoundRelationship"
}
]
},
{
"path": "Observation.related.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references).",
"min": 0,
"max": "1",
"type": [
{
"code": "id"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "Observation.related.extension",
"short": "Additional Content defined by implementations",
"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.",
"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.",
"synonym": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "Observation.related.modifierExtension",
"short": "Extensions that cannot be ignored",
"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.",
"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.",
"synonym": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "Observation.related.type",
"short": "has-component | has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by",
"definition": "A code specifying the kind of relationship that exists with the target observation.",
"comments": "A relationship type SHOULD be provided. If the relationship type is \"COMP\" (composed), then the observation should not be displayed/interpreted in the absence of the related observations.",
"requirements": "May need to indicate whether this observation is composed of others, or merely derived from them.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"binding": {
"name": "ObservationRelationshipType",
"isExtensible": false,
"conformance": "required",
"description": "Codes specifying how two observations are related",
"referenceReference": {
"reference": "http://hl7.org/fhir/vs/observation-relationshiptypes"
}
},
"mapping": [
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": ".typeCode"
}
]
},
{
"path": "Observation.related.target",
"short": "Observation that is related to this one",
"definition": "A reference to the observation that is related to this observation.",
"min": 1,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/Profile/Observation"
}
],
"mapping": [
{
"identity": "rim",
"map": ".targetObservation"
}
]
}
]
},
"differential": {
"element": [
{
"path": "Observation.code",
"fixedCodeableConcept": {
"coding": [
{
"system": "http://loinc.org",
"code": "2518-9"
}
]
}
},
{
"path": "Observation.valueQuantity.code",
"min": 1,
"max": "1",
"fixedCode": "mmol/L"
}
]
}
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
© HL7.org 2011+. FHIR DSTU (v0.4.0-4167) generated on Mon, Feb 23, 2015 09:18+1100.
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