minimal Common Oncology Data Elements (mCODE) Implementation Guide
3.0.0 - STU3 Release 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 (v3.0.0: STU 3) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). 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: 3.0.0
Draft as of 2023-10-25 Maturity Level: 1 Computable Name: Comorbidities

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:

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..*ObservationMeasurements and simple assertions
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... comorbidConditionPresent S0..*CodeableConcept, Reference(Condition)Related Condition Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
... comorbidConditionAbsent S0..*CodeableConceptRelated Condition Absent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
... code S1..1CodeableConceptType of observation (code / type)
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 398192003
... subject S0..1Reference(Cancer Patient Profile)Who and/or what the observation is about
... focus S0..*Reference(Primary Cancer Condition Profile)The Index Condition
... effective[x] S0..1dateTime, Period, Timing, instantClinically relevant time/time-period for observation
... value[x] 0..1Actual result
.... valueQuantityQuantity
.... valueIntegerinteger
... bodySite 0..1CodeableConceptNot used in this profile
... method 0..1CodeableConceptComorbidity framework used.
... specimen 0..1Reference(Specimen)Not used in this profile
... device 0..1Reference(Device | DeviceMetric)Not used in this profile
... hasMember 0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Not used in this profile
... component 0..*BackboneElementNot used in this profile

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... comorbidConditionPresent S0..*CodeableConcept, Reference(Condition)Related Condition Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.


Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 398192003
... subject SΣ0..1Reference(Cancer Patient Profile)Who and/or what the observation is about
... focus SΣ0..*Reference(Primary Cancer Condition Profile)The Index Condition
... effective[x] SΣ0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueIntegerinteger
... bodySite 0..1CodeableConceptNot used in this profile
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

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

... specimen 0..1Reference(Specimen)Not used in this profile
... device 0..1Reference(Device | DeviceMetric)Not used in this profile
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Not used in this profile
... component Σ0..*BackboneElementNot used in this profile
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.statusrequiredObservationStatus
Observation.codeexamplePattern: SNOMED CT code 398192003
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... comorbidConditionPresent S0..*CodeableConcept, Reference(Condition)Related Condition Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
... comorbidConditionAbsent S0..*CodeableConceptRelated Condition Absent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

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


... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 398192003
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣ0..1Reference(Cancer Patient Profile)Who and/or what the observation is about
... focus SΣ0..*Reference(Primary Cancer Condition Profile)The Index Condition
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣ0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueIntegerinteger
... dataAbsentReason C0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

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


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptNot used in this profile
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

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

... specimen 0..1Reference(Specimen)Not used in this profile
... device 0..1Reference(Device | DeviceMetric)Not used in this profile
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

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


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Not used in this profile
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component Σ0..*BackboneElementNot used in this profile
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.

.... value[x] Σ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason C0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, 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 / Code
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.codeexamplePattern: SNOMED CT code 398192003
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*ObservationMeasurements and simple assertions
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... comorbidConditionPresent S0..*CodeableConcept, Reference(Condition)Related Condition Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
... comorbidConditionAbsent S0..*CodeableConceptRelated Condition Absent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
... code S1..1CodeableConceptType of observation (code / type)
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 398192003
... subject S0..1Reference(Cancer Patient Profile)Who and/or what the observation is about
... focus S0..*Reference(Primary Cancer Condition Profile)The Index Condition
... effective[x] S0..1dateTime, Period, Timing, instantClinically relevant time/time-period for observation
... value[x] 0..1Actual result
.... valueQuantityQuantity
.... valueIntegerinteger
... bodySite 0..1CodeableConceptNot used in this profile
... method 0..1CodeableConceptComorbidity framework used.
... specimen 0..1Reference(Specimen)Not used in this profile
... device 0..1Reference(Device | DeviceMetric)Not used in this profile
... hasMember 0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Not used in this profile
... component 0..*BackboneElementNot used in this profile

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... comorbidConditionPresent S0..*CodeableConcept, Reference(Condition)Related Condition Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.


Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 398192003
... subject SΣ0..1Reference(Cancer Patient Profile)Who and/or what the observation is about
... focus SΣ0..*Reference(Primary Cancer Condition Profile)The Index Condition
... effective[x] SΣ0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueIntegerinteger
... bodySite 0..1CodeableConceptNot used in this profile
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

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

... specimen 0..1Reference(Specimen)Not used in this profile
... device 0..1Reference(Device | DeviceMetric)Not used in this profile
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Not used in this profile
... component Σ0..*BackboneElementNot used in this profile
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.statusrequiredObservationStatus
Observation.codeexamplePattern: SNOMED CT code 398192003
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.component.codeexampleLOINCCodes (a valid code from LOINC)

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... comorbidConditionPresent S0..*CodeableConcept, Reference(Condition)Related Condition Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
... comorbidConditionAbsent S0..*CodeableConceptRelated Condition Absent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

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


... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 398192003
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣ0..1Reference(Cancer Patient Profile)Who and/or what the observation is about
... focus SΣ0..*Reference(Primary Cancer Condition Profile)The Index Condition
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣ0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueIntegerinteger
... dataAbsentReason C0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

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


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptNot used in this profile
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

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

... specimen 0..1Reference(Specimen)Not used in this profile
... device 0..1Reference(Device | DeviceMetric)Not used in this profile
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

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


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Not used in this profile
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component Σ0..*BackboneElementNot used in this profile
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.

.... value[x] Σ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason C0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, 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 / Code
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.codeexamplePattern: SNOMED CT code 398192003
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

 

Other representations of profile: CSV, Excel, Schematron