Consolidated CDA (C-CDA)
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Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-ccda/ and changes regularly. See the Directory of published versions

Logical Model: OutcomeObservation - Detailed Descriptions

Draft as of 2024-12-19

Definitions for the OutcomeObservation logical model.

Guidance on how to interpret the contents of this table can be found here

0. Observation
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
should-value: SHOULD contain value (value.exists())
should-author: SHOULD contain author (author.exists())
2. Observation.templateId
Control1..?
SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • 4. Observation.templateId:outcome-obs
    Slice Nameoutcome-obs
    Control1..1
    6. Observation.templateId:outcome-obs.root
    Control1..?
    Pattern Value2.16.840.1.113883.10.20.22.4.144
    8. Observation.templateId:outcome-obs.extension
    Control0..0
    10. Observation.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:1098-31219).

    Fixed ValueOBS
    12. Observation.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001) (CONF:1098-31220).

    Fixed ValueEVN
    14. Observation.id
    Comments

    SHALL contain at least one [1..*] id (CONF:1098-31223).

    Control1..?
    16. Observation.code
    Comments

    SHALL contain exactly one [1..1] code, which SHOULD be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:1098-32746).

    18. Observation.text
    ShortSHOULD reference the portion of section narrative text corresponding to this entry
    20. Observation.text.reference
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    22. Observation.value
    Comments

    SHOULD contain zero or one [0..1] value (CONF:1098-32747).

    Control0..1
    24. Observation.author
    Comments

    SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1098-31553).

    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
    26. Observation.entryRelationship
    ShortWhere an Outcome Observation needs to reference an Intervention Act already described in the CDA document instance, rather than repeating the full content of the Intervention Act, the Entry Reference template may be used to reference this entry.
    Control1..?
    SlicingThis element introduces a set of slices on Observation.entryRelationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ typeCode
    • profile @ act
    • profile @ observation
    • 28. Observation.entryRelationship:goal-reference
      Slice Namegoal-reference
      ShortThe following entryRelationship represents the relationship between an Outcome Observation and a Goal Observation. Because the Goal Observation is already described in the CDA document instance's Goals section, rather than repeating the full content of the Goal Observation, the Entry Reference template can be used to reference this entry.
      Comments

      SHOULD contain zero or more [0..*] entryRelationship (CONF:1098-31224) such that it

      Control0..*
      Invariantsentry-ref-goal: This entryReference template **SHALL** reference an instance of a Goal Observation template. (%resource.descendants().ofType(CDA.Observation).where(templateId.exists($this.root = '2.16.840.1.113883.10.20.22.4.121' and $this.extension = '2022-06-01') and id.exists($this.root = %context.act.id.first().root and $this.extension ~ %context.act.id.first().extension)))
      30. Observation.entryRelationship:goal-reference.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="GEVL" Evaluates goal (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1098-31225).

      Fixed ValueGEVL
      32. Observation.entryRelationship:goal-reference.act
      Comments

      SHALL contain exactly one [1..1] Entry Reference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.122) (CONF:1098-32465).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act(Entry Reference)
      34. Observation.entryRelationship:progressTowardGoalObservation
      Slice NameprogressTowardGoalObservation
      ShortThe following entryRelationship represents the relationship between an Outcome Observation and a Progress Toward Goal Observation (Outcome Observation SUPPORTS Progress Toward Goal Observation). In the Care Planning workflow, the judgment about how well the person is progressing towards the goal is based on the observations made about the status of the patient with respect to interventions performed in the pursuit of achieving that goal.
      Comments

      SHOULD contain zero or one [0..1] entryRelationship (CONF:1098-31427) such that it

      Control0..1
      36. Observation.entryRelationship:progressTowardGoalObservation.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="SPRT" Has support (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1098-31428).

      Fixed ValueSPRT
      38. Observation.entryRelationship:progressTowardGoalObservation.inversionInd
      Comments

      SHALL contain exactly one [1..1] @inversionInd="true" (CONF:1098-31429).

      Control1..?
      Fixed Valuetrue
      40. Observation.entryRelationship:progressTowardGoalObservation.observation
      Comments

      SHALL contain exactly one [1..1] Progress Toward Goal Observation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.110) (CONF:1098-31430).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Progress Toward Goal Observation)
      42. Observation.entryRelationship:intervention-reference
      Slice Nameintervention-reference
      ShortWhere an Outcome Observation needs to reference an Intervention Act already described in the CDA document instance, rather than repeating the full content of the Intervention Act, the Entry Reference template may be used to reference this entry
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:1098-31688) such that it

      Control0..*
      Invariantsentry-ref-intervention: This entryReference template **SHALL** reference an instance of a Goal Observation template. (%resource.descendants().ofType(CDA.Observation).where(templateId.exists($this.root = '2.16.840.1.113883.10.20.22.4.131' and $this.extension = '2015-08-01') and id.exists($this.root = %context.act.id.first().root and $this.extension ~ %context.act.id.first().extension)))
      44. Observation.entryRelationship:intervention-reference.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="RSON" Has reason (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1098-31689).

      Fixed ValueRSON
      46. Observation.entryRelationship:intervention-reference.act
      Comments

      SHALL contain exactly one [1..1] Entry Reference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.122) (CONF:1098-31690).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act(Entry Reference)
      48. Observation.reference
      Comments

      MAY contain zero or more [0..*] reference (CONF:1098-32763).

      50. Observation.reference.typeCode
      Comments

      The reference, if present, SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1098-32764).

      Fixed ValueREFR
      52. Observation.reference.externalDocument
      Comments

      The reference, if present, SHALL contain exactly one [1..1] External Document Reference (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.115:2014-06-09) (CONF:1098-32765).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalDocument(External Document Reference)