Observation-example-glasgow.xml

Clinical assessment tool example - GCS using related Observations (id = "glasgow")

<Observation xmlns="http://hl7.org/fhir">
  <id value="glasgow"/>
  <text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: glasgow</p><p><b>contained</b>: , , </p><p><b>status</b>: final</p><p><b>code</b>: Glasgow Coma Scale , (GCS) <span>(Details : {LOINC code '9269-2' = 'Glasgow coma score total', given as 'Glasgow coma score
           total'})</span></p><p><b>subject</b>: <a>Peter James Chalmers</a></p><p><b>effective</b>: 11/12/2014 3:44:16 PM</p><p><b>value</b>: 13 {score}<span> (Details: http://unitsofmeasure.org code {score} = '{score}')</span></p><blockquote><p><b>referenceRange</b></p><p><b>high</b>: 8 {score}<span> (Details: http://unitsofmeasure.org code {score} = '{score}')</span></p><p><b>meaning</b>: Severe TBI <span>(Details )</span></p></blockquote><blockquote><p><b>referenceRange</b></p><p><b>low</b>: 9 {score}<span> (Details: http://unitsofmeasure.org code {score} = '{score}')</span></p><p><b>high</b>: 12 {score}<span> (Details: http://unitsofmeasure.org code {score} = '{score}')</span></p><p><b>meaning</b>: Moderate TBI <span>(Details )</span></p></blockquote><blockquote><p><b>referenceRange</b></p><p><b>low</b>: 13 {score}<span> (Details: http://unitsofmeasure.org code {score} = '{score}')</span></p><p><b>meaning</b>: Mild TBI <span>(Details )</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Motor score. Generated Summary: id: motor; status: final; GCS motor <span>(Details : {LOINC code '9268-4' = 'Glasgow coma score motor', given as 'Glasgow coma score
             motor'})</span>; ????; effective: 11/12/2014 3:44:16 PM; 5 (Localizes painful stimuli) <span>(Details : {http:/acme.ec/gcsmotor code '5' = '??', given as 'Localizes painful stimuli'};
             {LOINC code 'LA6566-9' = 'Localizing pain', given as 'Localizing pain'})</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Verbal score. Generated Summary: id: verbal; status: final; Verbal <span>(Details : {LOINC code '9270-0' = 'Glasgow coma score verbal', given as 'Glasgow coma
             score verbal'})</span>; ????; effective: 11/12/2014 3:44:16 PM; 4 (Confused, disoriented) <span>(Details : {http:/acme.ec/gcsverbal code '4' = '??', given as 'Confused, disoriented'};
             {LOINC code 'LA6560-2' = 'Confused', given as 'Confused'})</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Eyes score. Generated Summary: id: eyes; status: final; Eyes <span>(Details : {LOINC code '9267-6' = 'Glasgow coma score eye opening', given as 'Glasgow
             coma score eye opening'})</span>; ????; effective: 11/12/2014 3:44:16 PM; 4 (Opens eyes spontaneously) <span>(Details : {http:/acme.ec/gcseye code '4' = '??', given as 'Opens eyes spontaneously'};
             {LOINC code 'LA6556-0' = 'Eyes open spontaneously', given as 'Eyes open spontaneously'})</span></p></blockquote></div></text><contained>
  <!--     FHIR build is generating the narratives
<text>
    <status value="generated"></status>
     <div xmlns="http://www.w3.org/1999/xhtml">
     <h2>Observation: Glasgow Coma Scale , (GCS)</h2>
  <h3>Date Time: 2014-12-11 20:44PM</h3>
  <h3>Patient Name: Peter James Chalmers</h3>

    <ul>
      <li>
        <b>Glasgow Coma Scale , (GCS)=</b>13<ul>
          <li>
            <b>Motor=</b>5</li>
          <li>
            <b>Verbal=</b>4</li>
          <li>
            <b>Eyes=</b>4</li>
        </ul></li>
    </ul>

     </div>
  </text>
    -->
  <!--     Note: will use contained elements for this example but could just as easily use external
     or bundled elements..    -->
  <!--     First contained element = Motor component.     -->
    <Observation>
      <id value="motor"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://loinc.org"/>
          <code value="9268-4"/>
          <display value="Glasgow coma score motor"/>
        </coding>
        <text value="GCS motor"/>
      </code>
      <subject>
        <reference value="Patient/example"/>
      </subject>
      <effectiveDateTime value="2014-12-11T04:44:16Z"/>
      <valueCodeableConcept>
        <coding>
          <system value="http:/acme.ec/gcsmotor"/>
          <code value="5"/>
          <display value="Localizes painful stimuli"/>
        </coding>
        <coding>
        <!--      This example has the extension which maps a numeric score to the code this may already
           be known and unecessary in the Observation resource     -->
          <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
          <!--     from Element: extension     -->
            <valueDecimal value="5"/>
          <!--     0..1 Value of extension     -->
          </extension>
          <system value="http://loinc.org"/>
          <code value="LA6566-9"/>
          <display value="Localizing pain"/>
        </coding>
        <text value="5 (Localizes painful stimuli)"/>
      </valueCodeableConcept>
    </Observation>
  </contained>
  <contained>
  <!--     Second contained element = Verbal component.     -->
    <Observation>
      <id value="verbal"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://loinc.org"/>
          <code value="9270-0"/>
          <display value="Glasgow coma score verbal"/>
        </coding>
        <text value="Verbal"/>
      </code>
      <subject>
        <reference value="Patient/example"/>
      </subject>
      <effectiveDateTime value="2014-12-11T04:44:16Z"/>
      <valueCodeableConcept>
        <coding>
          <system value="http:/acme.ec/gcsverbal"/>
          <code value="4"/>
          <display value="Confused, disoriented"/>
        </coding>
        <coding>
        <!--      This example has the extension which maps a numeric score to the code this may already
           be known and unecessary in the Observation resource     -->
          <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
          <!--     from Element: extension     -->
            <valueDecimal value="4"/>
          <!--     0..1 Value of extension     -->
          </extension>
          <system value="http://loinc.org"/>
        <!--    technicallly the code is '5' and the LA is the identifier to do hav e both  would require
           an extention    -->
          <code value="LA6560-2"/>
          <display value="Confused"/>
        </coding>
        <text value="4 (Confused, disoriented)"/>
      </valueCodeableConcept>
    </Observation>
  </contained>
  <contained>
  <!--     Third contained element = Eyes component.     -->
    <Observation>
      <id value="eyes"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://loinc.org"/>
          <code value="9267-6"/>
          <display value="Glasgow coma score eye opening"/>
        </coding>
        <text value="Eyes"/>
      </code>
      <subject>
        <reference value="Patient/example"/>
      </subject>
      <effectiveDateTime value="2014-12-11T04:44:16Z"/>
      <valueCodeableConcept>
        <coding>
          <system value="http:/acme.ec/gcseye"/>
          <code value="4"/>
          <display value="Opens eyes spontaneously"/>
        </coding>
        <coding>
        <!--      This example has the extension which maps a numeric score to the code this may already
           be known and unecessary in the Observation resource     -->
          <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
          <!--     from Element: extension     -->
            <valueDecimal value="4"/>
          <!--     0..1 Value of extension     -->
          </extension>
          <system value="http://loinc.org"/>
        <!--    technicallly the code is '4' and the LA is the identifier to do hav e both  would require
           an extention    -->
          <code value="LA6556-0"/>
          <display value="Eyes open spontaneously"/>
        </coding>
        <text value="4 (Opens eyes spontaneously)"/>
      </valueCodeableConcept>
    </Observation>
  </contained>
<!--     the mandatory quality flags:     -->
  <status value="final"/>
<!--    
    Observations are often coded in multiple code systems.
      - LOINC
    - or SNOMED
      -and/or the source system may provides its own "local" code, which may be less or
   more granular than LOINC.
  In this example there is only LOINC
      -->
  <code>
  <!--     LOINC - always recommended to have a LOINC code     -->
    <coding>
      <system value="http://loinc.org"/>
      <code value="9269-2"/>
      <display value="Glasgow coma score total"/>
    </coding>
    <text value="Glasgow Coma Scale , (GCS)"/>
  </code>
  <subject>
    <reference value="Patient/example"/>
    <display value="Peter James Chalmers"/>
  </subject>
  <effectiveDateTime value="2014-12-11T04:44:16Z"/>
<!--     In FHIR, units may be represented twice. Once in the
    agreed human representation, and once in a coded form.
    In this example the UCUM unit is provided but no human representation since this is
   often not displayed
       -->
  <valueQuantity>
    <value value="13"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="{score}"/>
  </valueQuantity>
  <referenceRange>
    <high>
      <value value="8"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="{score}"/>
    </high>
  <!--     meaning as text     -->
    <meaning>
      <text value="Severe TBI"/>
    </meaning>
  </referenceRange>
  <referenceRange>
    <low>
      <value value="9"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="{score}"/>
    </low>
    <high>
      <value value="12"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="{score}"/>
    </high>
  <!--     meaning as text     -->
    <meaning>
      <text value="Moderate TBI"/>
    </meaning>
  </referenceRange>
  <referenceRange>
    <low>
      <value value="13"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="{score}"/>
    </low>
  <!--     meaning as text     -->
    <meaning>
      <text value="Mild TBI"/>
    </meaning>
  </referenceRange>
<!--     put the references to the contained components here using the derived-From type  
      -->
  <related>
    <type value="derived-from"/>
    <target>
      <reference value="#motor"/>
      <display value="Motor score"/>
    </target>
  </related>
  <related>
    <type value="derived-from"/>
    <target>
      <reference value="#verbal"/>
      <display value="Verbal score"/>
    </target>
  </related>
  <related>
    <type value="derived-from"/>
    <target>
      <reference value="#eyes"/>
      <display value="Eyes score"/>
    </target>
  </related>
</Observation>