Australian Digital Health Agency FHIR Implementation Guide, published by Australian Digital Health Agency. This guide is not an authorized publication; it is the continuous build for version 1.2.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/ci-fhir-r4/ and changes regularly. See the Directory of published versions

Resource Profile: ADHA Visual Acuity Observation ( Experimental )

Official URL: http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-observation-visualacuity-1 Version: 0.1.1
Draft as of 2025-03-21 Computable Name: ADHAObservationVisualAcuity

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This resource includes SNOMED Clinical Terms™ (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists. “SNOMED” and “SNOMED CT” are registered trademarks of the IHTSDO.

The rights to use and implement or implementation of SNOMED CT content are limited to the extent it is necessary to allow for the end use of this material. No further rights are granted in respect of the International Release and no further use of any SNOMED CT content by any other party is permitted.

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The purpose of this profile is to represent an observation of patient’s visual acuity, for the electronic exchange of health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.

This profile identifies the additional constraints, extensions, and value sets that build on and extend Observation that are supported.

This profile is designed to set an Observation standard for:

  • TBD

This profile may be referred to by APIs, which will be listed here when available.

This content will be taken for discussion with HL7 Australia and may be removed or changed.

Profile specific guidance

Whether the measured vision is corrected or uncorrected should be recorded in the observation code.

The use of a pinhole occluder should be recorded as an additional coding in observation code.

The eye or eyes whose vision is measured should be recorded as a body site.

The type of chart used should be recorded as a device type.

Results in Snellen notation should be recorded as ratios, see example Distance visual acuity, both eyes, as a ratio.

Results in N-point notation should be recorded as quantities, see example Near visual acuity, right eye, in N-point notation.

Results of low vision should be recorded as coded terms, see example Distance visual acuity, left eye, as a code.

Undefined terminology resources include:

  • for category, a code for a category of "Vision"
  • for code, a value set containing the SNOMED CT codes for types of visual acuity test
  • for code, SNOMED CT codes for distance visual acuity, corrected; distance visual acuity, uncorrected; near visual acuity, corrected; near visual acuity, uncorrected
  • for valueCodeableConcept, a value set containing the SNOMED CT codes for low vision results
  • for valueQuantity, a code for unit of measurement for LogMAR notation
  • for valueQuantity, a code for unit of measurement for N-point notation
  • for valueQuantity, a code for unit of measurement for M-size notation
  • for bodySite, a value set containing the SNOMED CT codes for left, right and both eyes.
  • for method, a value set containing the SNOMED CT codes for the types of chart commonly used in Australia.

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Sharpness or acuteness of vision
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: 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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.


ele-1: All FHIR elements must have a @value or children
Fixed Value: final
.... category:exam 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


ele-1: All FHIR elements must have a @value or children

Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: exam
... code Σ 1..1 CodeableConcept Type of observation (code / type)
Binding: ValueSet[http://snomed.info/sct?fhir_vs|http://snomed.info/sct/32506021000036107] . (preferred): Visual Acuity Test


ele-1: All FHIR elements must have a @value or children
... subject Σ 1..1 Reference(Patient) Who and/or what the observation is about
ele-1: All FHIR elements must have a @value or children
... effective[x] Σ 1..1 dateTime Clinically relevant time/time-period for observation
ele-1: All FHIR elements must have a @value or children
... Slices for value[x] ΣC 0..1 Actual result
Slice: Unordered, Closed by type:$this
ele-1: All FHIR elements must have a @value or children
.... valueRatio Ratio
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
.... value[x]:valueRatio ΣC 0..1 Ratio Visual acuity expressed as a Snellen fraction
ele-1: All FHIR elements must have a @value or children
inv-dh-va-01: Value shall include numerator value and denominator value
.... value[x]:valueQuantity ΣC 0..1 Quantity Visual acuity expressed as a simple quantity
ele-1: All FHIR elements must have a @value or children
inv-dh-va-02: Value shall include value and unit
.... value[x]:valueCodeableConcept ΣC 0..1 CodeableConcept Visual acuity expressed as a code
ele-1: All FHIR elements must have a @value or children
... method 0..1 CodeableConcept Method used to measure visual acuity
Binding: ObservationMethods (example): Methods for simple observations.


ele-1: All FHIR elements must have a @value or children
... device 0..1 Reference(Device | DeviceMetric) Type of chart used to measure visual acuity
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.statusrequiredFixed Value: final
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:exampreferredPattern: exam
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codepreferred . (a valid code from SNOMED CT)
http://snomed.info/sct?fhir_vs
Observation.methodexampleObservationMethods
http://hl7.org/fhir/ValueSet/observation-methods
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
inv-dh-va-01errorObservation.value[x]:valueRatioValue shall include numerator value and denominator value
: numerator.value.exists() and denominator.value.exists()
inv-dh-va-02errorObservation.value[x]:valueQuantityValue shall include value and unit
: value.exists() and unit.exists()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

No mandatory or optional search parameters for ADHA Visual Acuityprofile.