minimal Common Oncology Data Elements (mCODE) Implementation Guide
4.0.0-ballot - STU4 Ballot United States of America flag

This page is part of the HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU1 (v4.0.0-ballot: STU4 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: Comorbidities Profile

Official URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-comorbidities Version: 4.0.0-ballot
Active as of 2024-04-10 Maturity Level: 1 Computable Name: Comorbidities
Other Identifiers: OID:2.16.840.1.113883.4.642.40.15.42.15

General structure for capturing comorbid conditions with respect to a primary (‘index’) condition. The user can use this profile in three ways: (1) free-form, listing any conditions they wish to highlight as significant comorbidities, (2) following a formal paradigm such as the Charlson Comorbidity Index or the NCI Comorbidity Index, or (3) use disease categories defined for registry reporting purposes, such as those defined by Center for International Blood and Marrow Transplant Research (CIBMTR).

Background

“Comorbidity” speaks to the presence of more than one distinct condition in an individual. Typically, the term refers to additional disorders relative to a current “index” disease (Valderas, et al.).

Co-occurring disorders are typically treated as high-level categories, for example, “liver disease, mild”, “dementia”, or “renal disease”. Comorbidity categories are not universal, but rather, selected because of their clinical significance to the diagnosis, prognosis, or treatment of the index disease. The comorbidities significant in COVID-19 treatment are different than those for congestive heart failure.

There are several general models used to note the presence of multiple disease categories in one individual, typically used to calculate a morbidity burden or risk score. The Charlson Comorbidity Index is one of the most widely used. The NCI Comorbidity Index is similar, however, the NCI comorbidities exclude solid tumors, leukemias, and lymphomas, given that the index was developed from a cohort of cancer patients. However, there is no uniform way to record comorbidities, and therefore mCODE does not impose any particular framework.

FHIR Implementation Overview

The user can use this profile in three ways: (1) free-form, listing any conditions they wish to highlight as significant comorbidities, (2) by following a formal paradigm, such as Charlson or Elixhauser, or (3) use codes defined for registry reporting purposes, such as codes defined by Center for International Blood and Marrow Transplant Research (CIBMTR). This profile contains two extensions, representing comorbidities that are present and those asserted to be absent.

Index Condition

Record the “index” condition (the condition the comorbidities are relevant to) in Observation.focus. Reference the patient’s primary cancer condition.

Comorbidities Present

Comorbidities that are present are reported in the array Observation.extension:comorbidConditionPresent as a valueReference or valueCodeableConcept. The use of valueReference is optional and applicable only if there is an existing Condition resource representing the comorbid condition. In other cases, a diagnosis code or a comorbid condition category code appears in valueCodeableConcept.

Typically, a cancer condition would not be considered a comorbidity in a cancer patient, but it is possible that there could be a pre-existing or concurrent cancer condition included in the list of comorbidities.

Comorbidities Absent

Usually, only comorbidities that are present are recorded. However, assertions of absent comorbidities are useful when calculating comorbid risk indices. To assert a comorbidity is not present, the array Observation.extension:comorbidConditionAbsent is populated with either a diagnosis code or comorbid condition category code.

No Comorbidities

To represent no comorbidities, there should be only one entry in Observation.extension:comorbidConditionAbsent with the valueCodeableConcept of SNOMED CT ID 64572001 (Disease).

Comorbidity Method

If a formal methodology is used to assess comorbidities (e.g., Charlson, NCI, Elixhauser, CIMBTR, ACE-27), it should be identified in Observation.method. The comorbidity score (Observation.value) cannot be interpreted without knowing the method. The method may also provide the comorbidity categories used in present and absent comorbidities.

At present, only Charlson has a specific SNOMED CT code, so in other cases, a plain text can be specified in Observation.method.text.

Comorbidity Index or Risk Score

A comorbid condition risk index, if it exists, is reported in Observation.value[x]. In several frameworks the index is an integer, so the value would appear as Observation.valueInteger.

Conformance

Observation resources associated with an in-scope patient with Observation.code of SCT#398192003 “Co-morbid conditions (finding)” SHALL conform to this profile. Beyond this requirement, a producer of resources SHOULD ensure that any resource instance associated with an in-scope patient that would reasonably be expected to conform to this profile SHOULD be published in this form.

Usage:

Changes since version true:

  • No changes

    • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation 0..* Observation Measurements and simple assertions
    ... Slices for extension S 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ... comorbidConditionPresent S 0..* CodeableConcept, Reference(Condition) Related Condition Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
    ... comorbidConditionAbsent S 0..* CodeableConcept Related Condition Absent Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
    ... code S 1..1 CodeableConcept Type of observation (code / type)
    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://snomed.info/sct
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 398192003
    ... subject S 0..1 Reference(Cancer Patient Profile) Who and/or what the observation is about
    ... focus S 0..* Reference(Primary Cancer Condition Profile) The Index Condition
    ... effective[x] S 0..1 dateTime, Period, Timing, instant Clinically relevant time/time-period for observation
    ... value[x] 0..1 Actual result
    .... valueQuantity Quantity
    .... valueInteger integer
    ... bodySite 0..1 CodeableConcept Not used in this profile
    ... method 0..1 CodeableConcept Comorbidity framework used.
    ... specimen 0..1 Reference(Specimen) Not used in this profile
    ... device 0..1 Reference(Device | DeviceMetric) Not used in this profile
    ... hasMember 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Not used in this profile
    ... component 0..* BackboneElement Not used in this profile

    doco Documentation for this format
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* Observation Measurements and simple assertions
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension S 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ... comorbidConditionPresent S 0..* CodeableConcept, Reference(Condition) Related Condition Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required): Codes providing the status of an observation.

    ... code SΣ 1..1 CodeableConcept Type of observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.


    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://snomed.info/sct
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 398192003
    ... subject SΣ 0..1 Reference(Cancer Patient Profile) Who and/or what the observation is about
    ... focus SΣ 0..* Reference(Primary Cancer Condition Profile) The Index Condition
    ... effective[x] SΣ 0..1 Clinically relevant time/time-period for observation
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    .... effectiveTiming Timing
    .... effectiveInstant instant
    ... value[x] ΣC 0..1 Actual result
    .... valueQuantity Quantity
    .... valueInteger integer
    ... bodySite 0..1 CodeableConcept Not used in this profile
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept Comorbidity framework used.
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Not used in this profile
    ... device 0..1 Reference(Device | DeviceMetric) Not used in this profile
    ... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Not used in this profile
    ... component Σ 0..* BackboneElement Not used in this profile
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code Σ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.


    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.codeexamplePattern: SNOMED CT code 398192003
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* Observation Measurements and simple assertions
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension S 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ... comorbidConditionPresent S 0..* CodeableConcept, Reference(Condition) Related Condition Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
    ... comorbidConditionAbsent S 0..* CodeableConcept Related Condition Absent Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required): Codes providing the status of an observation.

    ... category 0..* CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ... code SΣ 1..1 CodeableConcept Type of observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.


    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://snomed.info/sct
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 398192003
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... subject SΣ 0..1 Reference(Cancer Patient Profile) Who and/or what the observation is about
    ... focus SΣ 0..* Reference(Primary Cancer Condition Profile) The Index Condition
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SΣ 0..1 Clinically relevant time/time-period for observation
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    .... effectiveTiming Timing
    .... effectiveInstant instant
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
    ... value[x] ΣC 0..1 Actual result
    .... valueQuantity Quantity
    .... valueInteger integer
    ... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite 0..1 CodeableConcept Not used in this profile
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept Comorbidity framework used.
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Not used in this profile
    ... device 0..1 Reference(Device | DeviceMetric) Not used in this profile
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    obs-3: Must have at least a low or a high or text
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... low C 0..1 SimpleQuantity Low Range, if relevant
    .... high C 0..1 SimpleQuantity High Range, if relevant
    .... type 0..1 CodeableConcept Reference range qualifier
    Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

    .... appliesTo 0..* CodeableConcept Reference range population
    Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


    .... age 0..1 Range Applicable age range, if relevant
    .... text 0..1 string Text based reference range in an observation
    ... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Not used in this profile
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) Related measurements the observation is made from
    ... component Σ 0..* BackboneElement Not used in this profile
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code Σ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.

    .... value[x] Σ 0..1 Actual component result
    ..... valueQuantity Quantity
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    .... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    .... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeexamplePattern: SNOMED CT code 398192003
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
    http://hl7.org/fhir/ValueSet/referencerange-meaning
    from the FHIR Standard
    Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
    http://hl7.org/fhir/ValueSet/referencerange-appliesto
    from the FHIR Standard
    Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard

    Differential View

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation 0..* Observation Measurements and simple assertions
    ... Slices for extension S 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ... comorbidConditionPresent S 0..* CodeableConcept, Reference(Condition) Related Condition Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
    ... comorbidConditionAbsent S 0..* CodeableConcept Related Condition Absent Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
    ... code S 1..1 CodeableConcept Type of observation (code / type)
    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://snomed.info/sct
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 398192003
    ... subject S 0..1 Reference(Cancer Patient Profile) Who and/or what the observation is about
    ... focus S 0..* Reference(Primary Cancer Condition Profile) The Index Condition
    ... effective[x] S 0..1 dateTime, Period, Timing, instant Clinically relevant time/time-period for observation
    ... value[x] 0..1 Actual result
    .... valueQuantity Quantity
    .... valueInteger integer
    ... bodySite 0..1 CodeableConcept Not used in this profile
    ... method 0..1 CodeableConcept Comorbidity framework used.
    ... specimen 0..1 Reference(Specimen) Not used in this profile
    ... device 0..1 Reference(Device | DeviceMetric) Not used in this profile
    ... hasMember 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Not used in this profile
    ... component 0..* BackboneElement Not used in this profile

    doco Documentation for this format

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* Observation Measurements and simple assertions
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension S 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ... comorbidConditionPresent S 0..* CodeableConcept, Reference(Condition) Related Condition Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required): Codes providing the status of an observation.

    ... code SΣ 1..1 CodeableConcept Type of observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.


    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://snomed.info/sct
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 398192003
    ... subject SΣ 0..1 Reference(Cancer Patient Profile) Who and/or what the observation is about
    ... focus SΣ 0..* Reference(Primary Cancer Condition Profile) The Index Condition
    ... effective[x] SΣ 0..1 Clinically relevant time/time-period for observation
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    .... effectiveTiming Timing
    .... effectiveInstant instant
    ... value[x] ΣC 0..1 Actual result
    .... valueQuantity Quantity
    .... valueInteger integer
    ... bodySite 0..1 CodeableConcept Not used in this profile
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept Comorbidity framework used.
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Not used in this profile
    ... device 0..1 Reference(Device | DeviceMetric) Not used in this profile
    ... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Not used in this profile
    ... component Σ 0..* BackboneElement Not used in this profile
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code Σ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.


    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.codeexamplePattern: SNOMED CT code 398192003
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* Observation Measurements and simple assertions
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension S 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ... comorbidConditionPresent S 0..* CodeableConcept, Reference(Condition) Related Condition Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
    ... comorbidConditionAbsent S 0..* CodeableConcept Related Condition Absent Extension
    URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required): Codes providing the status of an observation.

    ... category 0..* CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ... code SΣ 1..1 CodeableConcept Type of observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.


    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://snomed.info/sct
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 398192003
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... subject SΣ 0..1 Reference(Cancer Patient Profile) Who and/or what the observation is about
    ... focus SΣ 0..* Reference(Primary Cancer Condition Profile) The Index Condition
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SΣ 0..1 Clinically relevant time/time-period for observation
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    .... effectiveTiming Timing
    .... effectiveInstant instant
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
    ... value[x] ΣC 0..1 Actual result
    .... valueQuantity Quantity
    .... valueInteger integer
    ... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite 0..1 CodeableConcept Not used in this profile
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept Comorbidity framework used.
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Not used in this profile
    ... device 0..1 Reference(Device | DeviceMetric) Not used in this profile
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    obs-3: Must have at least a low or a high or text
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... low C 0..1 SimpleQuantity Low Range, if relevant
    .... high C 0..1 SimpleQuantity High Range, if relevant
    .... type 0..1 CodeableConcept Reference range qualifier
    Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

    .... appliesTo 0..* CodeableConcept Reference range population
    Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


    .... age 0..1 Range Applicable age range, if relevant
    .... text 0..1 string Text based reference range in an observation
    ... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Not used in this profile
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) Related measurements the observation is made from
    ... component Σ 0..* BackboneElement Not used in this profile
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code Σ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.

    .... value[x] Σ 0..1 Actual component result
    ..... valueQuantity Quantity
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    .... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    .... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeexamplePattern: SNOMED CT code 398192003
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
    http://hl7.org/fhir/ValueSet/referencerange-meaning
    from the FHIR Standard
    Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
    http://hl7.org/fhir/ValueSet/referencerange-appliesto
    from the FHIR Standard
    Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard

     

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