Continua Personal Health Device Data Implementation Guide

Phd Numeric Observation JSON Example

This page is part of the Personal Health Device FHIR IG (v0.1.0: STU 1 Draft) based on FHIR R3. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Phd Numeric Observation Profile

The Numeric Observation Profile is used when the PHD metric measurement contains one of the following attributes:

Attribute	Value	Additional Information
Basic-Nu-Observed-Value	16-bit Mder SFLOAT	12-bit mantissa
Simple-Nu-Observed-Value	32-bit Mder FLOAT	24-bit mantissa
Nu-Observed-Value	32-bit Mder FLOAT	Complex attribute. Also contains metric-id measurement status unit-code

These attributes contain a measurement value that is a single number. The Mder SFLOAT and FLOAT encodings indicate both precision and the number of significant figures. The Observation.valueQuantity.value element is required to honor the reported precision. See the section Mder FLOATs and SFLOATs for instructions on handling Mder S/FLOATs and their encoding to the valueQuantity .

The structure definition for this profile is as follows:

Name	Card.	Type
Observation		Observation	Short description: Simple Numeric measurement Definition: The PhdNumericObservation reports PHD measurements that contain one of either a Basic-Nu-Observed-Value, Simple-Nu_observed-Value, or Nu_observed-Value attribute. Comments: Used for non-compound numeric observations from Personal Health Devices Data Type Observation
meta	1..
profile	1..		Sliced: Unordered, Open, by PhdNumericObservation(Value)
phdProfile	1..1	Fixed Value	Fixed Value: PhdNumericObservation
identifier			Sliced: Ordered, Open, by value(Value)
conditionalCreateIdentifier	..1		Short description: Unique identifier of this measurment for a given patient and device Definition: An identifier created from a combination of the measurement parameters like sensor time stamp, type code, value, units code, patient and device identifiers, and selected elements of any component elements. Requirements: Allows observations to be distinguished in a selective enough manner to prevent resource duplication. Comments: This value is used in the conditional create to prevent data duplication. PHDs will often re-send already sent data for a variety of reasons. This element is required unless the metric measurement contains no time stamp or is a measurement containing a time stamp that is real time. By real time the time stamp reported by the PHD must be later than the current time reported by the PHD before any measurements are received. Temporarily stored data from IEEE 11073 20601 devices, which are required to delete the data after sending, can also be considered real time. Temporarily stored data from Bluetooth Low Energy Health devices may be resent so these cannot be considered as real time.
value	1..
code
11073Type			Comments: For non-compound 11073-20601 metric numeric measurements, this code is obtained from one or more of the Type, Metric-Id, Nu-Observed-Value, and Metric-Id-Partition attributes. The algorithm to get the 16-bit partition and 16-bit term code is as follows: The partition and term code are obtained from the Type attribute. If there is a Metric-Id attribute the term code comes from this attribute. If there is a Nu-Observed-Value attribute the term code comes from this attribute. If the term code is NOT from the Type attribute, and there is a Metric-Id-Partition attribute, the partition comes from this attribute. The 32-bit 11073-10101 code value is given by partition * 2 **16 + term code. It is this value that is placed in the code.coding.code element for this 11073Type slice
valueQuantity		Quantity	Data Type Quantity
value	1..		Definition: The decoded Mder FLOAT or SFLOAT value from a PHD measurement containing either a Basic-Nu_observed-Value Simple-Nu-Observed-Value or Nu_observed-Value attribute. Comments: The implicit precision in the value shall be honored. The Mder encoding used in the above attributes provides this precision. The translating software shall honor that precision when generating this value. This element shall be present unless there is an error reported in the Measurement-Status attribute or the Nu-Observed-Value.status field or the Mder encoding represents one of the special values. In that case there is a dataAbsentValue element and the valueQuantity element is not present. Note that not all measurement status values are errors resulting in no measurement being reported here; for example the preliminary or verified status.
unit			Definition: A human-readable form of the unit. In this profile it is strongly recommended to put in the UCUM code for this unit. UCUM codes are typcially familar human-readable strings. It is not required in this profile as it may not be known and organizations may have their own requirements.
system	1..	Fixed Value	Fixed Value: urn:iso:std:iso:11073:10101
code	1..		Definition: The 32-bit 11073 10101 code for the units of this measurement. Comments: The 11073-10101 code is used as this comes from the device. This usage allows gateways responsible for translating device measurements to FHIR to handle future specializations they may introduce new codes. If a translation to another coding system is done instead, that gateway would not be able to process the measurement.
dataAbsentReason			Definition: Provides a reason why the expected value in the element Observation.valueQuantity is missing. This could be a NaN (Not a Number), PINF (Positive infinity), NINF (Negative infinity) or an error condition indicated by the Measurement-Status attribute. Comments: The current values in the http://hl7.org/fhir/data-absent-reason system do not provide the same detailed set of options reported in the numeric attributes. For example, the PINF, NINF, and not at this resolution special values have no matching codes. In those cases one uses the generic 'error' code.
coding	1..1
system	1..
code	1..
accuracyComponent	..1		Definition: This component shall be present if the accuracy attribute is present.
code
coding	1..		Sliced: Ordered, Open, by code(Value)
11073Type	1..1
system	1..	Fixed Value	Fixed Value: urn:iso:std:iso:11073:10101
code	1..	Fixed Value	Definition: The code for the accuracy attribute is 67914 Fixed Value: 67914
display			Definition: Should include the reference identifier for the Accuracy-Attribute MDC_ATTR_NU_ACCUR_MSMT
valueQuantity	1..	Quantity	Data Type Quantity
value	1..		Definition: This is the value of the accuracy attribute. The value is Mder FLOAT encoded and shall be expressed to the precision indicated by the Mder FLOAT.
unit			Definition: A human-readable form of the unit. One should put the UCUM code for the units in this display string. It shall match the UCUM code in Observation.valueQuantity.unit if UCUM is used there.
system	1..	Fixed Value	Definition: The unit code shall use the MDC system Fixed Value: urn:iso:std:iso:11073:10101
code	1..		Definition: The units are given by the units of the measurement so this shall have the code as in Observation.valueQuantity.code
dataAbsentReason	..0
alertOpStateComponent			Definition: This component gives one of the settings reported in the Alert-Op-State attribute. This attribute is used only by the Pulse Oximeter specialization. The Alert-Op-State attribute is used in conjunction with the Current-Limits and Measurement-Status attributes. The Current-Limits defines upper and lower limit thresholds for a reported measurement value. When the reported measurement value goes below or above these limits, a bit is set in the Measurement-Status attribute is set if the Alert-Op-State attribute indicates that the alert is active for the given threshold. Since it is considered important that if a Current-Limits attribute is present an alert shall be sent went the thresholds are crossed, the Alert-Op-State Bits are only set when the alert is, for some reason, turned OFF for a given threshold. There shall be one such alertOpStateComponent entry for every bit set in the Alert-Op-State attribute. There may be an entry for the defined cleared components as well. Requirements: This component indicates if a given alert condition is turned off. Comments: Recall that when creating the code for this entry that the code uses the MDER-Bit setting to be reported along with the Alert-Op-State attribute's MDC code. MDER-Bit 0 is the most significant bit of the attribute value. Since the Alert-Op-State attribute is a BITS-16 value, MDER-Bit 0 would have value 0x8000 and MDER-Bit 1 would have value 0x4000. Only bits 0, 1, and 2 are defined for this attribute.
code
coding	1..1		Comments: Normally alternative coding systems are allowed but in this case the value is intimately tied to the code. The code represents the feature indicated by a bit settin in the attribute value. which is either cleared (0) or set (1). Thus the value for this entry is itself a binary 'Y' or 'N' code from http://hl7.org/fhir/v2/0136
system	1..	Fixed Value	Fixed Value: http://hl7.org/fhir/IEEE.ASN1
code	1..		Definition: This code, which is an alpha-numeric string, is generated by the attribute MDC code, which is 68746 for the Alert-Op-State, followed by a dot (.) followed by the MDER-bit that was set. Given that only three bits are defined in the Pulse Ox specialization that uses this attribute, the code will be one of 68746.0, 68746.1. or 68746.2 Comments: Note that this code is an alpha-numeric string and not a decimal number. Think of it like a very-limited OID.
valueCodeableConcept	1..	CodeableConcept	Data Type CodeableConcept
coding	1..1
system	1..	Fixed Value	Definition: This coding system contains only two entries, 'Y' (yes) and 'N' (no) Fixed Value: http://hl7.org/fhir/v2/0136
code	1..		Definition: If the MDER-Bit is set, the code value is 'Y' otherwise it is 'N' Comments: Recall that when the value is 'Y' the alarm or alert is turned off
dataAbsentReason	..0
currentLimitsComponent	..1		Definition: The Current-Limits attribute gives upper and lower threshhold values for the triggering of an alert for the measured value being reported in this Observation resource. This attribute is currently used only in the Pulse Oximeter specialization. If the alerting is not turned off, a Measurement-Status attribute bit is set when either threshold is crossed. The Current-Limits attribute value shall be reported if it is present in the measurement. Requirements: Allows the downstream signaling of an alert and/or warning situation. Comments: The value is expressed as a range. The lower and upper values of the range represent the thresholds.
code
coding	1..		Sliced: Ordered, Open, by system(Value)
11073Type	1..1
system	1..	Fixed Value	Definition: Indicates the MDC coding system Comments: The code is that of the Current-Limits attribute Fixed Value: urn:iso:std:iso:11073:10101
code	1..	Fixed Value	Definition: Shall be the code of the Current-Limits attribute. Fixed Value: 67892
display			Definition: Should include the reference id for the Current-Limits attribute which is MDC_ATTR_LIMIT_CURR
valueRange	1..	Range	Data Type Range
SimpleQuantity	1..
value	1..		Definition: Thsi value is given by Current-Limits.lower as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct. Comments: This gives the lower threshold. If the measurement falls below this value, the Measurement-Status attribute is sent with a bit stating the alert is present (if the alerts are not turned off for the lower limits).
unit			Definition: A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present.
system	1..	Fixed Value	Definition: Indicates the MDC coding system. Fixed Value: urn:iso:std:iso:11073:10101
code	1..		Definition: This code (which is the code for the units) shall be the same as Observation.valueQuantity.code Comments: The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader.
SimpleQuantity	1..		Comments: The high limit shall be present
value	1..		Definition: Thsi value is given by Current-Limits.upper as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct. Comments: This gives the upper threshold. If the measurement goes above this value, the Measurement-Status attribute is sent with a bit stating the alert is present (if the alerts are not turned off for the upper limits).
unit			Definition: A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present.
system	1..	Fixed Value	Definition: Indicates the MDC coding system. Fixed Value: urn:iso:std:iso:11073:10101
code	1..		Definition: This code (which is the code for the units) shall be the same as Observation.valueQuantity.code Comments: The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader.
dataAbsentReason	..0
alertOpTextStringComponent	..1		Definition: This component reports the values in the Alert-Op-Text-String attribute. Reporting the this attribute information is optional. Comments: This attribute consists of human readable strings giving further information about the upper and lower limits
code
coding	1..		Sliced: Ordered, Open, by code(Value)
11073Type	1..1
system	1..	Fixed Value	Fixed Value: urn:iso:std:iso:11073:10101
code	1..	Fixed Value	Definition: The MDC code for the Alert-Op-Text-String attribute Fixed Value: 68104
display			Definition: The reference identifier for the attribute should be included. The Alert-Op-Text-String attribute ref id is MDC_ATTR_AL_OP_TEXT_STRING
valueString	1..	string	Data Type string
value	1..		Definition: This is the value of the lower and upper text strings presented in an application specific manner.
dataAbsentReason	..0
measurementConfidence95Component	..1		Definition: The Measurement-Confidence-95 attribute defines the lower and upper bounds for a range within which the manufacture is 95% confident that the actual value resides. The unit for the lower bound and upper bound is the same as the measurement. Requirements: Provides a level of confidence for the reported measurement.
code
coding	1..		Sliced: Ordered, Open, by system(Value)
11073Type	1..1
system	1..	Fixed Value	Definition: Indicates the MDC coding system Comments: The code is that of the Current-Limits attribute Fixed Value: urn:iso:std:iso:11073:10101
code	1..	Fixed Value	Definition: Shall be the code of the Current-Limits attribute. Fixed Value: 526998
display			Definition: Should include the reference id for the Current-Limits attribute which is MDC_ATTR_MSMT_CONFIDENCE_95
valueRange	1..	Range	Data Type Range
SimpleQuantity	1..
value	1..		Definition: Thsi value is given by Measurement-Confidence-95.lower-bound as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct. Comments: This gives the lower value for the manufacturer is 95% confident that the measurement reported is that of the real value.
unit			Definition: A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present.
system	1..	Fixed Value	Definition: Indicates the MDC coding system. Fixed Value: urn:iso:std:iso:11073:10101
code	1..		Definition: This code (which is the code for the units) shall be the same as Observation.valueQuantity.code Comments: The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader.
SimpleQuantity	1..		Comments: The high limit shall be present
value	1..		Definition: Thsi value is given by Measurement-Confidence-95.upper-bound as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct. Comments: This gives the upper value for the manufacturer is 95% confident that the measurement reported is that of the real value.
unit			Definition: A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present.
system	1..	Fixed Value	Definition: Indicates the MDC coding system. Fixed Value: urn:iso:std:iso:11073:10101
code	1..		Definition: This code (which is the code for the units) shall be the same as Observation.valueQuantity.code Comments: The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader.
dataAbsentReason	..0
thresholdNotificationTextStringComponent	..1		Definition: This component reports the values in the Threshold-Notification-Text-String attribute. Reporting the this attribute information is optional. Comments: This attribute consists of human readable strings giving further information threshold notification(s)
code
coding	1..		Sliced: Ordered, Open, by code(Value)
11073Type	1..1
system	1..	Fixed Value	Fixed Value: urn:iso:std:iso:11073:10101
code	1..	Fixed Value	Definition: The MDC code for the Threshold-Notification-Text-String attribute Fixed Value: 68232
display			Definition: The reference identifier for the attribute should be included. The Threshold-Notification-Text-String attribute ref id is MDC_ATTR_THRES_NOTIF_TEXT_STRING
valueString	1..	string	Data Type string
value	1..		Definition: This is the value of the text string.
dataAbsentReason	..0

Mapping Numerics to FHIR

The following table shows how the numeric attributes are mapped to FHIR. Since the FHIR Quantity also contains the units the Unit-Code attribute value is required to complete the picture.

Attribute	FHIR coding
Basic-Nu-Observed-Value.value Unit-Code.code	Observation.valueQuantity.value Observation.valueQuantity.code
Simple-Nu-Observed-Value.value Unit-Code.code	Observation.valueQuantity.value Observation.valueQuantity.code
Nu-Observed-Value.value Nu-Observed-Value.unit Nu-Observed-Value.metric-id Nu-Observed-Value.status	Observation.valueQuantity.value Observation.valueQuantity.code effects Observation.code see Obtaining the Observation.code handle measurement status see Phd Base Observation Profile

Conditional Create Identifier Generation

For a general description of the PHD Profile Identifier see the "PHD Profile Identifier" section in Phd Base Profile. The table below lists the items that make up the identifier.

Entry	value	Additional information
device	"PhdParentDeviceComponent.identifier.value"	This value is the PHD IEEE EUI-64 system identifier
patient	"Patient.identifier.value-Patient.identifier.system" or provided logical id	The dashes are part of the identifier. When the service provider gives the PHG a pre-determined patient logical id the PHG creates no Patient resource and has no patient information. In that special case the provided logical id is used
type	"Observation.code.coding.code"	See Obtaining the Observation.code
value	"Observation.valueQuantity.value" or "Observation.dataAbsentReason.coding.code	The numerical value of the measurement or the data absent reason if the value is not present
units	"Observation.valueQuantity.code"	The 32-bit MDC code for the units
reported PHD timestamp	"timestamp"	See Generating the PHD Reported Time Stamp
supplemental types	"Supplemental-Types.N-"	A sequence of 32-bit MDC codes separated by a dash

The final identifier is made by concatenating the entries above as follows:

"device-patient-type-value-units-reported PHD timestamp-supplemental types"

Additional Numerical Measurement Information

11073 20601 numeric metric measurements have some additional optional attributes that are used only for numerics. When they occur, these additional attributes provide further information about the measurement. An example of such a numeric-only additional attribute is one that describes the accuracy of the measurement. The accuracy is a measure of the deviation of the actual measurement from the reported measurement. Consequently, 'accuracy' is not a concept that makes any sense in the context of a measurement which is one or more of a finite set of enumerated codes such as a glucose-monitor meal assoication (breakfast, snack, fasting, etc.), and thus the attribute is not used in Enumration metrics.

As in the PhdBaseObservation profile, an Observation.component element is used to contain the additional information. There are five metric attributes that give extra information about numeric-only measurements.

Accuracy

The Accuracy attribute gives the maximum deviation as an absolute value of the reported measurement from the actual measurement over the entire range of the measurement. The reported accuracy is, thus, static and does not vary over the range of the measurement. It shall be reported if the PHD provides it and it is not corrupted. It is in the units of the measurement itself. The entries are as populated as follows:

Observation.component element	entry	Additional Information
.code.coding.code	67914	This is the MDC code for the Accuracy attribute
.code.coding.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.code.coding.display	optional but	Should contain the reference id MDC_ATTR_NU_ACCUR_MSMT along with any other additional text
.valueQuantity.value	the value	This is accuracy value
.valueQuantity.unit	optional but	Should contain the UCUM string and shall match the UCUM string of the primary measurement
.valueQuantity.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.valueQuantity.code	shall be the code of the primary measurement	The code shall be the MDC unit code

Alert Operational State

The Alert Operational State is currently only used in the Pluse Oximeter specialization. This attribute uses an ASN1-BITs field to indicate whether the alerts on a given limit (upper or lower) are on or off. When SET, the alerts are off. This is a state-type measurement and when this attribute is present, both the set and cleared states are reported. Three bits are defined thus there will be three component entries for each of the bits.

Observation.component element	entry	Additional Information
.code.coding.code	68746.n	68746 is the MDC code for the Alert Operational State. 'n' is 0, 1, or 2 depending upon which bit is being reported.
.code.coding.system	http://hl7.org/fhir/IEEE.ASN1	Indicates the ASN-1 coding system
.code.coding.display	optional but	Should contain the ASN1 name 'lim-alert-off', 'lim-low-off', or 'lim-high-off' for bits 0-2, respectively, along with any other additional text
.valueCodeableConcept.coding.code	'Y' or 'N'	'Y' for bit set, 'N' for bit cleared
.valueCodeableConcept.coding.system	http://hl7.org/fhir/v2/0136	Indicates the V2 binary coding system

Alert Operational Text String

This attributes provides a human readable string describing the lower and upper threshold limits. It is currently used only in the Pulse Oximeter specialization.

Observation.component element	entry	Additional Information
.code.coding.code	68104	This is the MDC code for the Alert-Operational-Text_string attribute
.code.coding.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.code.coding.display	optional but	Should contain the reference id MDC_ATTR_AL_OP_TEXT_STRING along with any other additional text
.valueString	the strings	These are the lower and upper limit strings

Current Limits

The Current-Limits attribute is currently only used in the Pluse Oximeter specialization. It gives the lower and upper threshold limits of whatever measurement is being monitored.

Observation.component element	entry	Additional Information
.code.coding.code	67892	This is the MDC code for the Current-Limits attribute
.code.coding.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.code.coding.display	optional but	Should contain the reference id MDC_ATTR_LIMIT_CURR along with any other additional text
.valueRange.low.value	the value	This is the lower limit
.valueRange.low.unit	optional but	Should contain the UCUM string and shall match the UCUM string of the primary measurement
.valueRange.low.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.valueRange.low.code	shall be the code of the primary measurement	The code shall be the MDC unit code
.valueRange.high.value	the value	This is the upper limit
.valueRange.high.unit	optional but	Should contain the UCUM string and shall match the UCUM string of the primary measurement
.valueRange.high.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.valueRange.high.code	shall be the code of the primary measurement	The code shall be the MDC unit code

Measurement Confidence 95

The Measurement-Confidence-95 attribute is currently used only in the Continuous Glucose specialization. The attribute gives a lower and upper bound with which the manufacturer is 95%confident that the actual reported measurement is within that bounds.

Observation.component element	entry	Additional Information
.code.coding.code	526998	This is the MDC code for the Measurement-Confidence-95 attribute
.code.coding.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.code.coding.display	optional but	Should contain the reference id MDC_ATTR_MSMT_CONFIDENCE_95 along with any other additional text
.valueRange.low.value	the value	This is the lower limit
.valueRange.low.unit	optional but	Should contain the UCUM string and shall match the UCUM string of the primary measurement
.valueRange.low.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.valueRange.low.code	shall be the code of the primary measurement	The code shall be the MDC unit code
.valueRange.high.value	the value	This is the upper limit
.valueRange.high.unit	optional but	Should contain the UCUM string and shall match the UCUM string of the primary measurement
.valueRange.high.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.valueRange.high.code	shall be the code of the primary measurement	The code shall be the MDC unit code

Threshold Notification Text String

The Threshold-Notification-Text-String attribute is currently used only in the Continuous Glucose specialization. It provides a human readable string describing the thresholds. There are separate measurement objects that actually give the thresholds.

Observation.component element	entry	Additional Information
.code.coding.code	68232	This is the MDC code for the Alert-Operational-Text_string attribute
.code.coding.system	urn:iso:std:iso:11073:10101	Indicates the MDC coding system
.code.coding.display	optional but	Should contain the reference id MDC_ATTR_THRES_NOTIF_TEXT_STRING along with any other additional text
.valueString	the string	This is a texual description of the thresholds for the given measurement

Consumer of the Phd Numeric Observation Profile

The consumer of this profile does not need to concern itself with the mapping complexities or the phd-related entry for the Observation.identifier which is used by the uploader to prevent data duplication. There are no extensions introduced by this profile so the resource is consumable by any reader that understands the Observation resource. The following table summarizes the elements used describing the measurement:

Measurement item	element	Additional Information
measurement type	Observation.code.coding.code	The first coding element is always MDC The second coding element is LOINC if a vital sign
measurement value	Observation.valueQuantity.value	Value has precision of original measurement
measurement units	Observation.valueQuantity.code	Uses MDC coding system. Observation.valueQuantity.unit contains UCUM string if known
error	Observation.dataAbsentReason	Contains error code. If present no Observation.valueQuantity is present
time stamp	Observation.dateTimeEffective Observation.period	If the measurement is a point in time. If the measurement has a duration.
coincident time stamp	Observation.related.target.reference	Points to Observation following the Coincident Time Stamp Observation profile. For time quality auditing purposes. Not present if the sensor provides NO time stamp
related measurement	Observation.related.target.reference	Points to a PHD Observation that is related to this Observation such as a cardio session. Will NOT be a coincident time stamp observation
additional descriptions	Observation.component	If a component element exists it contains additional information about the measurement
patient	Observation.subject	Points to the Patient resource
sensor device	Observation.device	Points to the DeviceComponent resource

Phd Numeric Observation JSON Example

The following JSON example is a pulse rate measurment from a Blood Pressure Cuff.

{
    "resourceType":"Observation",
    "meta":{
        "profile": [
            "http://pchalliance.org/phdfhir/StructureDefinition/PhdNumericObservation"
        ]
    },
    "identifier": [
        {
            "value":"sisansarahId-urn:oid:1.2.3.4.5.6.7.8.10-01040302f0000000-149546-20171212091343-48-264864"
        }
    ],
    "status":"final",
    "category": [
        {
            "coding": [
                {
                    "system":"http://hl7.org/fhir/observation-category",
                    "code":"vital-signs",
                    "display":"Vital Signs"
                }
            ]
        }
    ],
    "code":{
        "coding": [
            {
                "system":"urn:iso:std:iso:11073:10101",
                "code":"149546",
                "display":"MDC_PULS_RATE_NON_INV"
            },
            {
                "system":"http://loinc.org",
                "code":"8867-4",
                "display":"Blood Pressure cuff heart rate"
            }
        ]
    },
    "subject":{
        "reference":"Patient/PatientId-sisansarahId"
    },
    "effectiveDateTime":"2017-12-12T09:13:43-05:00",
    "performer": [
        {
            "reference":"Patient/PatientId-sisansarahId"
        }
    ],
    "valueQuantity":{
        "value":"48",
        "unit":"{beat}/min",
        "system":"urn:iso:std:iso:11073:10101",
        "code":"264864"
    },
    "device":{
        "reference":"DeviceComponent/SysId-01040302f0000000"
    },
    "related": [
        {
            "id":"coincidentTimeStampRelated",
            // The presence of this Coincident Time Stamp Observation
            // reference indicates that the PHD provided the time
            // stamp and the time is not the time of reception by the PHG.

            "type":"qualified-by",
            "target":{
                "reference":"urn:oid:3.14159.20171212091339"
                // The reason for this funny logical id is that this
                // resource is extracted from a Bundle upload where the Coincident Time Stamp
                // Observation is present. A temporary id is used and when the server receives
                // the Bundle, the server creates a logical id for the Coincident Time Stamp
                // Observation and changes all the temporary ids accordingly. When this resource
                // is saved on the server, the above temporary id will be the server-assigned
                // logical id of the Coincident Time Stamp Observation 
            }
        }
    ]
}