HL7.FHIR.US.QICORE\QICore Observation

QI-Core Implementation Guide
5.0.0 - STU5 United States of America flag

This page is part of the Quality Improvement Core Framework (v5.0.0: STU5 (v5.0.0)) based on FHIR R4. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Resource Profile: QICore Observation

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation				Version: 5.0.0
Active as of 2018-08-22				Computable Name: QICoreObservation

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

Usage

Note: US-Core and QI-Core define precise profiles for specific observations, as well as a general profile for LOINC-code laboratory result observations. QI-Core inherits these US Core specific profiles directly and individually profiles others. When creating expressions for eCQMs or CDS artifacts with QI-Core for the following clinical data, use the applicable profile directly rather than the generic QICore Observation profile:

As stated in the Home Page, QI Core derives from US Core and so the requirements on “MustSupport” defined in US Core must be respected. QI Core further describes and constrains the “MustSupport” functionality.

To create an expression specifically requesting information that an observation intentionally did not occur for a medical, patient or system reason, use the profile QICore-observationcancelled.

The following example illustrates the use of the observation profile.

define "Pap Test with Results":
  [Observation: "Pap Test"] PapTest
    where PapTest.value is not null
      and PapTest.status in { 'final', 'amended', 'corrected', 'preliminary' }

See the patterns page for implementation and usage patterns.

Examples

Example of a Frailty Observation

Example of a Gestation Age at Birth Observation

Usage:

Formal Views of Profile Content

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

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	Measurements and simple assertions
bodyPosition		0..1	CodeableConcept	The body position during the observation URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition Binding: QICore Observation Body Position (preferred): SNOMED CT code system values descending from the following:'body position finding' 9851009
basedOn		0..*	Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ServiceRequest)	Fulfills plan, proposal or order
status	S	1..1	code	registered \| prliminary \| final \| amended \| corrected \| entered-in-error \| unknown Binding: Non-Negative Observation Status (required)
category	S	1..*	CodeableConcept	Classification of type of observation
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): This value set specifies the type of observation
subject	S	1..1	Reference(QICore Patient S \| QICore Device S \| QICore Location S \| US Core Implantable Device Profile S)	Who and/or what the observation is about
encounter	S	0..1	Reference(QICore Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime S
effectivePeriod			Period S
effectiveTiming			Timing S
effectiveInstant			instant S
issued	S	0..1	instant	Date/Time this version was made available
performer	S	0..*	Reference(QICore Practitioner \| QICore Organization \| QICore Patient \| QICore RelatedPerson)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept S
valueString			string S
valueBoolean			boolean S
valueInteger			integer S
valueRange			Range S
valueRatio			Ratio S
valueSampledData			SampledData
valueTime			time S
valueDateTime			dateTime S
valuePeriod			Period S
value[x]:valueCodeableConcept	S	0..1	CodeableConcept	Actual result Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
dataAbsentReason		0..1	CodeableConcept	Why the result is missing
interpretation	S	0..*	CodeableConcept	High, low, normal, etc.
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (preferred): Codes describing anatomical locations. May include laterality.
method	S	0..1	CodeableConcept	How it was done Binding: ObservationMethods (preferred): Methods for simple observations
specimen	S	0..1	Reference(QICore Specimen)	Specimen used for this observation
device		0..1	Reference(QICore Device \| DeviceMetric)	(Measurement) Device
referenceRange		0..*	BackboneElement	Provides guide for interpretation
low		0..1	SimpleQuantity	Low Range, if relevant
high		0..1	SimpleQuantity	High Range, if relevant
derivedFrom		0..*	Reference(QICore Observation \| QuestionnaireResponse)	Related measurements the observation is made from
component	S	0..*	BackboneElement	Component results
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
value[x]	SΣ	0..1		Actual component result
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept S
valueString			string S
valueBoolean			boolean S
valueInteger			integer S
valueRange			Range S
valueRatio			Ratio S
valueSampledData			SampledData
valueTime			time S
valueDateTime			dateTime S
valuePeriod			Period S
dataAbsentReason	S	0..1	CodeableConcept	Why the component result is missing
interpretation	S	0..*	CodeableConcept	High, low, normal, etc.
referenceRange		0..*		Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.extension:bodyPosition [CanonicalType[http://hl7.org/fhir/StructureDefinition/observation-bodyPosition]]	preferred	QICoreObservationBodyPosition
Observation.status	required	NonNegativeObservationStatus
Observation.code	preferred	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueCodeableConcept	preferred	USCoreObservationValueCodes (a valid code from SNOMED CT)
Observation.bodySite	preferred	SNOMEDCTBodyStructures
Observation.method	preferred	ObservationMethods
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC)

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	Measurements and simple assertions
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
bodyPosition		0..1	CodeableConcept	The body position during the observation URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	0..*	Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ServiceRequest)	Fulfills plan, proposal or order
status	?!SΣ	1..1	code	registered \| prliminary \| final \| amended \| corrected \| entered-in-error \| unknown Binding: Non-Negative Observation Status (required)
category	S	1..*	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 (preferred): This value set specifies the type of observation
subject	SΣ	1..1	Reference(QICore Patient \| QICore Device \| QICore Location \| US Core Implantable Device Profile)	Who and/or what the observation is about
encounter	SΣ	0..1	Reference(QICore 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	SΣ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(QICore Practitioner \| QICore Organization \| QICore Patient \| QICore RelatedPerson)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (preferred): Codes describing anatomical locations. May include laterality.
method	S	0..1	CodeableConcept	How it was done Binding: ObservationMethods (preferred): Methods for simple observations
specimen	S	0..1	Reference(QICore Specimen)	Specimen used for this observation
device		0..1	Reference(QICore Device \| DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation
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
derivedFrom	Σ	0..*	Reference(QICore Observation \| QuestionnaireResponse)	Related measurements the observation is made from
component	SΣ	0..*	BackboneElement	Component results
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
value[x]	SΣ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation	S	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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Observation.status	required	NonNegativeObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.code	preferred	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueCodeableConcept	preferred	USCoreObservationValueCodes (a valid code from SNOMED CT)
Observation.dataAbsentReason	extensible	DataAbsentReason
Observation.interpretation	extensible	ObservationInterpretationCodes
Observation.bodySite	preferred	SNOMEDCTBodyStructures
Observation.method	preferred	ObservationMethods
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC)
Observation.component.dataAbsentReason	extensible	DataAbsentReason
Observation.component.interpretation	extensible	ObservationInterpretationCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If 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-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()