Clinical Document Architecture
2.0.0-sd - release

Clinical Document Architecture, published by Health Level 7. This guide is not an authorized publication; it is the continuous build for version 2.0.0-sd built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-core-sd/ and changes regularly. See the Directory of published versions

: CDAObservationInterpretation - JSON Representation

Draft as of 2024-05-16

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{
  "resourceType" : "ValueSet",
  "id" : "CDAObservationInterpretation",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li>Include these codes as defined in <a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html\"><code>http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-B\">B</a></td><td style=\"color: #cccccc\">Better</td><td>The current result or observation value has improved compared to the previous result or observation value (the change is significant as defined in the respective test procedure).<br/><br/>\\[Note: This can be applied to quantitative or qualitative observations.\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-D\">D</a></td><td style=\"color: #cccccc\">Significant change down</td><td>The current result has decreased from the previous result for a quantitative observation (the change is significant as defined in the respective test procedure).</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-U\">U</a></td><td style=\"color: #cccccc\">Significant change up</td><td>The current result has increased from the previous result for a quantitative observation (the change is significant as defined in the respective test procedure).</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-W\">W</a></td><td style=\"color: #cccccc\">Worse</td><td>The current result or observation value has degraded compared to the previous result or observation value (the change is significant as defined in the respective test procedure).<br/><br/>\\[Note: This can be applied to quantitative or qualitative observations.\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-.60\">&lt;</a></td><td style=\"color: #cccccc\">Off scale low</td><td>The result is below the minimum detection limit (the test procedure or equipment is the limiting factor).<br/><br/>Synonyms: Below analytical limit, low off scale.</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-.62\">&gt;</a></td><td style=\"color: #cccccc\">Off scale high</td><td>The result is above the maximum quantifiable limit (the test procedure or equipment is the limiting factor).<br/><br/>Synonyms: Above analytical limit, high off scale.</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-A\">A</a></td><td style=\"color: #cccccc\">Abnormal</td><td>The result or observation value is outside the reference range or expected norm (as defined for the respective test procedure).<br/><br/>\\[Note: Typically applies to non-numeric results.\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-AA\">AA</a></td><td style=\"color: #cccccc\">Critical abnormal</td><td>The result or observation value is outside a reference range or expected norm at a level at which immediate action should be considered for patient safety (as defined for the respective test procedure).<br/><br/>\\[Note: Typically applies to non-numeric results. Analogous to critical/panic limits for numeric results.\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-HH\">HH</a></td><td style=\"color: #cccccc\">Critical high</td><td>The result for a quantitative observation is above a reference level at which immediate action should be considered for patient safety (as defined for the respective test procedure).<br/><br/>Synonym: Above upper panic limits.</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-LL\">LL</a></td><td style=\"color: #cccccc\">Critical low</td><td>The result for a quantitative observation is below a reference level at which immediate action should be considered for patient safety (as defined for the respective test procedure).<br/><br/>Synonym: Below lower panic limits.</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-H\">H</a></td><td style=\"color: #cccccc\">High</td><td>The result for a quantitative observation is above the upper limit of the reference range (as defined for the respective test procedure).<br/><br/>Synonym: Above high normal</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-L\">L</a></td><td style=\"color: #cccccc\">Low</td><td>The result for a quantitative observation is below the lower limit of the reference range (as defined for the respective test procedure).<br/><br/>Synonym: Below low normal</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-N\">N</a></td><td style=\"color: #cccccc\">Normal</td><td>The result or observation value is within the reference range or expected norm (as defined for the respective test procedure).<br/><br/>\\[Note: Applies to numeric or non-numeric results.\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-I\">I</a></td><td style=\"color: #cccccc\">Intermediate</td><td>Bacterial strain inhibited in vitro by a concentration of an antimicrobial agent that is associated with uncertain therapeutic effect. Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmonized\\_Terminolo.htm) Projects: ISO 20776-1, ISO 20776-2<br/><br/>\\[Note 1: Bacterial strains are categorized as intermediate by applying the appropriate breakpoints in a defined phenotypic test system.\\]<br/><br/>\\[Note 2: This class of susceptibility implies that an infection due to the isolate can be appropriately treated in body sites where the drugs are physiologically concentrated or when a high dosage of drug can be used.\\]<br/><br/>\\[Note 3: This class also indicates a &quot;buffer zone,&quot; to prevent small, uncontrolled, technical factors from causing major discrepancies in interpretations.\\]<br/><br/>\\[Note 4: These breakpoints can be altered due to changes in circumstances (e.g., changes in commonly used drug dosages, emergence of new resistance mechanisms).\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-MS\">MS</a></td><td style=\"color: #cccccc\">moderately susceptible</td><td>The patient is considered as carrier based on the testing results. A carrier is an individual who carries an altered form of a gene which can lead to having a child or offspring in future generations with a genetic disorder.<br/><br/>***Deprecation Comment:*** This antimicrobial susceptibility test interpretation concept is recommended by OO to be deprecated as it is no longer recommended for use in susceptibility testing by CLSI (reference CLSI document M100-S22; Vol. 32 No.3; CLSI Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. Jan 2012).</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-R\">R</a></td><td style=\"color: #cccccc\">Resistant</td><td>Bacterial strain inhibited in vitro by a concentration of an antimicrobial agent that is associated with a high likelihood of therapeutic failure. Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmonized\\_Terminolo.htm) Projects: ISO 20776-1, ISO 20776-2<br/><br/>\\[Note 1: Bacterial strains are categorized as resistant by applying the appropriate breakpoints in a defined phenotypic test system.\\]<br/><br/>\\[Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes in commonly used drug dosages, emergence of new resistance mechanisms).\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-S\">S</a></td><td style=\"color: #cccccc\">Susceptible</td><td>Bacterial strain inhibited by in vitro concentration of an antimicrobial agent that is associated with a high likelihood of therapeutic success. Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmonized\\_Terminolo.htm) Synonym (earlier term): Sensitive Projects: ISO 20776-1, ISO 20776-2<br/><br/>\\[Note 1: Bacterial strains are categorized as susceptible by applying the appropriate breakpoints in a defined phenotypic system.\\]<br/><br/>\\[Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes in commonly used drug dosages, emergence of new resistance mechanisms).\\]</td></tr><tr><td><a href=\"http://terminology.hl7.org/5.2.0/CodeSystem-v3-ObservationInterpretation.html#v3-ObservationInterpretation-VS\">VS</a></td><td style=\"color: #cccccc\">very susceptible</td><td>The patient is considered as carrier based on the testing results. A carrier is an individual who carries an altered form of a gene which can lead to having a child or offspring in future generations with a genetic disorder.<br/><br/>***Deprecation Comment:*** This antimicrobial susceptibility test interpretation concept is recommended by OO to be deprecated as it is no longer recommended for use in susceptibility testing by CLSI (reference CLSI document M100-S22; Vol. 32 No.3; CLSI Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. Jan 2012).</td></tr></table></li></ul></div>"
  },
  "url" : "http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation",
  "version" : "2.0.0-sd",
  "name" : "CDAObservationInterpretation",
  "title" : "CDAObservationInterpretation",
  "status" : "draft",
  "experimental" : false,
  "date" : "2024-05-16T19:22:49+00:00",
  "publisher" : "Health Level 7",
  "contact" : [
    {
      "name" : "HL7 International - Structured Documents",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/structure"
        },
        {
          "system" : "email",
          "value" : "structdog@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "One or more codes providing a rough qualitative interpretation of the observation - limited to values available in original CDA",
  "compose" : {
    "include" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
        "concept" : [
          {
            "code" : "B"
          },
          {
            "code" : "D"
          },
          {
            "code" : "U"
          },
          {
            "code" : "W"
          },
          {
            "code" : "<"
          },
          {
            "code" : ">"
          },
          {
            "code" : "A"
          },
          {
            "code" : "AA"
          },
          {
            "code" : "HH"
          },
          {
            "code" : "LL"
          },
          {
            "code" : "H"
          },
          {
            "code" : "L"
          },
          {
            "code" : "N"
          },
          {
            "code" : "I"
          },
          {
            "code" : "MS"
          },
          {
            "code" : "R"
          },
          {
            "code" : "S"
          },
          {
            "code" : "VS"
          }
        ]
      }
    ]
  }
}