Qi-Core Implementation Guide (Release 2.1 Trial-Use Ballot)

This page is part of the Quality Improvement Core Framework (v2.1.0: STU 3 Ballot 1) based on FHIR R3. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

D.4.1 StructureDefinition: qicore-observation

Examples:

Decreased Hemoglobin Example

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is: 

http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation

Profile of Observation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

This profile builds on Observation.

This profile was published on Mon Aug 21 00:00:00 AEST 2017 as a draft by Health Level Seven International (Clinical Quality Information - QICore).

Description of Profiles, Differentials, and Snapshots.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*
... id 0..1id
... basedOn 0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ProcedureRequest), Reference(ReferralRequest)
... status S1..1code
... category S1..*CodeableConcept
... code S1..1CodeableConcept
... subject S1..1Reference(QICore-Patient), Reference(Group), Reference(QICore-Device), Reference(QICore-Location)
... context S0..1Reference(QICore-Encounter), Reference(Group)
... effective[x] S0..1dateTime, Period
... issued S0..1instant
... performer 0..*Reference(QICore-Practitioner), Reference(QICore-Organization), Reference(QICore-Patient), Reference(QICore-RelatedPerson)
... value[x] S0..1Quantity, CodeableConcept, string, boolean, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodBinding: Observation Value Codes (SNOMED-CT) (preferred)
... dataAbsentReason 0..1CodeableConcept
... interpretation S0..1CodeableConcept
... bodySite S0..1CodeableConcept
... method S0..1CodeableConcept
... specimen S0..1Reference(QICore-Specimen)
... device 0..1Reference(QICore-Device), Reference(DeviceMetric)
... referenceRange 0..*BackboneElement
.... low 0..1SimpleQuantity
.... high 0..1SimpleQuantity
... related S0..*BackboneElement
.... target 1..1Reference(QICore-Observation), Reference(QuestionnaireResponse)
... component S0..*BackboneElement
.... code S1..1CodeableConcept
.... value[x] S0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, Period
.... dataAbsentReason S0..1CodeableConcept
.... interpretation S0..1CodeableConcept
.... referenceRange 0..*
... observation-bodyPosition 0..1CodeableConceptThe body position during the observation
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
Binding: Body Position (preferred)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*Measurements 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: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... observation-bodyPosition I0..1CodeableConceptExtension
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ProcedureRequest), Reference(ReferralRequest)Fulfills plan, proposal or order
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category S1..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINC Codes (example)
... subject SΣ1..1Reference(QICore-Patient), Reference(Group), Reference(QICore-Device), Reference(QICore-Location)Who and/or what this is about
... context S0..1Reference(QICore-Encounter), Reference(Group)Healthcare event during which this observation is made
... effective[x] SΣ0..1dateTime, PeriodClinically relevant time/time-period for observation
... issued SΣ0..1instantDate/Time this was made available
... performer Σ0..*Reference(QICore-Practitioner), Reference(QICore-Organization), Reference(QICore-Patient), Reference(QICore-RelatedPerson)Who is responsible for the observation
... value[x] SΣI0..1Quantity, CodeableConcept, string, boolean, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual result
Binding: Observation Value Codes (SNOMED-CT) (preferred)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation S0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite S0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method S0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen S0..1Reference(QICore-Specimen)Specimen used for this observation
... device 0..1Reference(QICore-Device), Reference(DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... related SΣI0..*BackboneElementResource related to this observation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 0..1codehas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
Binding: ObservationRelationshipType (required)
.... target 1..1Reference(QICore-Observation), Reference(QuestionnaireResponse)Resource that is related to this one
... component SΣI0..*BackboneElementComponent results
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code SΣ1..1CodeableConceptType of component observation (code / type)
Binding: LOINC Codes (example)
.... value[x] SΣ0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual component result
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation S0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*
... id 0..1id
... basedOn 0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ProcedureRequest), Reference(ReferralRequest)
... status S1..1code
... category S1..*CodeableConcept
... code S1..1CodeableConcept
... subject S1..1Reference(QICore-Patient), Reference(Group), Reference(QICore-Device), Reference(QICore-Location)
... context S0..1Reference(QICore-Encounter), Reference(Group)
... effective[x] S0..1dateTime, Period
... issued S0..1instant
... performer 0..*Reference(QICore-Practitioner), Reference(QICore-Organization), Reference(QICore-Patient), Reference(QICore-RelatedPerson)
... value[x] S0..1Quantity, CodeableConcept, string, boolean, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodBinding: Observation Value Codes (SNOMED-CT) (preferred)
... dataAbsentReason 0..1CodeableConcept
... interpretation S0..1CodeableConcept
... bodySite S0..1CodeableConcept
... method S0..1CodeableConcept
... specimen S0..1Reference(QICore-Specimen)
... device 0..1Reference(QICore-Device), Reference(DeviceMetric)
... referenceRange 0..*BackboneElement
.... low 0..1SimpleQuantity
.... high 0..1SimpleQuantity
... related S0..*BackboneElement
.... target 1..1Reference(QICore-Observation), Reference(QuestionnaireResponse)
... component S0..*BackboneElement
.... code S1..1CodeableConcept
.... value[x] S0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, Period
.... dataAbsentReason S0..1CodeableConcept
.... interpretation S0..1CodeableConcept
.... referenceRange 0..*
... observation-bodyPosition 0..1CodeableConceptThe body position during the observation
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
Binding: Body Position (preferred)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*Measurements 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: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... observation-bodyPosition I0..1CodeableConceptExtension
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ProcedureRequest), Reference(ReferralRequest)Fulfills plan, proposal or order
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category S1..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINC Codes (example)
... subject SΣ1..1Reference(QICore-Patient), Reference(Group), Reference(QICore-Device), Reference(QICore-Location)Who and/or what this is about
... context S0..1Reference(QICore-Encounter), Reference(Group)Healthcare event during which this observation is made
... effective[x] SΣ0..1dateTime, PeriodClinically relevant time/time-period for observation
... issued SΣ0..1instantDate/Time this was made available
... performer Σ0..*Reference(QICore-Practitioner), Reference(QICore-Organization), Reference(QICore-Patient), Reference(QICore-RelatedPerson)Who is responsible for the observation
... value[x] SΣI0..1Quantity, CodeableConcept, string, boolean, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual result
Binding: Observation Value Codes (SNOMED-CT) (preferred)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation S0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite S0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method S0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen S0..1Reference(QICore-Specimen)Specimen used for this observation
... device 0..1Reference(QICore-Device), Reference(DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... related SΣI0..*BackboneElementResource related to this observation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 0..1codehas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
Binding: ObservationRelationshipType (required)
.... target 1..1Reference(QICore-Observation), Reference(QuestionnaireResponse)Resource that is related to this one
... component SΣI0..*BackboneElementComponent results
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code SΣ1..1CodeableConceptType of component observation (code / type)
Binding: LOINC Codes (example)
.... value[x] SΣ0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual component result
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation S0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathNameConformanceValueSet
Observation.languageCommon LanguagesextensibleCommon Languages
Observation.statusObservationStatusrequiredObservationStatus
Observation.categoryObservation Category CodespreferredObservation Category Codes
Observation.codeLOINC CodesexampleLOINC Codes
Observation.value[x]Observation Value Codes (SNOMED-CT)preferredObservation Value Codes (SNOMED-CT)
Observation.dataAbsentReasonObservation Value Absent ReasonextensibleObservation Value Absent Reason
Observation.interpretationObservation Interpretation CodesextensibleObservation Interpretation Codes
Observation.bodySiteSNOMED CT Body StructuresexampleSNOMED CT Body Structures
Observation.methodObservation MethodsexampleObservation Methods
Observation.referenceRange.typeObservation Reference Range Meaning CodesextensibleObservation Reference Range Meaning Codes
Observation.referenceRange.appliesToObservation Reference Range Applies To CodesexampleObservation Reference Range Applies To Codes
Observation.related.typeObservationRelationshipTyperequiredObservationRelationshipType
Observation.component.codeLOINC CodesexampleLOINC Codes
Observation.component.dataAbsentReasonObservation Value Absent ReasonextensibleObservation Value Absent Reason
Observation.component.interpretationObservation Interpretation CodesextensibleObservation Interpretation Codes

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2ObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-1ObservationIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.empty()
dom-4ObservationIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-3ObservationIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
: contained.where(('#'+id in %resource.descendants().reference).not()).empty()
obs-7ObservationIf code is the same as a component code then the value element associated with the code SHALL NOT be present
: value.empty() or code!=component.code
obs-6ObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
ele-1Observation.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Observation.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Observation.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.referenceRangeAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
obs-3Observation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
ele-1Observation.relatedAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Observation.componentAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())