US Quality Core Implementation Guide
1.0.0-ballot - STU 1 - ballot United States of America flag

US Quality Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-quality-core/ and changes regularly. See the Directory of published versions

Resource Profile: US Quality Core Simple Observation

Official URL: http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-simple-observation Version: 1.0.0-ballot
Standards status: Trial-use Maturity Level: 4 Computable Name: USQualityCoreSimpleObservation
Other Identifiers: OID:2.16.840.1.113883.4.642.40.78.42.50

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

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

USCDI+ Quality Element Support Expectations

Systems are expected to support this profile as part of implementing USCDI+ Quality V2 in FHIR and meeting the conformance requirements of this guide.

The following elements are specifically relevant to USCDI+ Quality V2 data classes and elements. Systems are expected to support these elements as applicable to their role in US Quality Core data exchange. See the Must Support section of this guide for more information. These elements are flagged as (USCDI+ Quality) in the formal profile views.

USCDI+ Quality Elements:

Profile element Description USCDI+ Quality Data Element(s)
category Classification of type of observation Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use
category:us-core US Core classification of type of observation Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use
code Type of observation (code / type) Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use, Newborn's Delivery Information: Birth Outcome, Newborn's Delivery Information: Birth Weight, Newborn's Delivery Information: Gestational Age at Delivery, Newborn's Delivery Information: Birth Date and Time, Pregnancy Information: Estimated Date of Delivery, Pregnancy Information: Fetal Presentation, Pregnancy Information: Gestational Age, Pregnancy Information: Gravidity, Pregnancy Information: Parity, Pregnancy Information: Pregnancy Outcomes, Pregnancy Information: Preterm Births, Pregnancy Information: Term Births, Pregnancy Information: Delivery Date and Time
effective[x] Clinically relevant time/time-period for observation Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use
performer Who is responsible for the observation Provenance: Author
status registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use
value[x] Actual result Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use, Newborn's Delivery Information: Birth Outcome, Newborn's Delivery Information: Birth Weight, Newborn's Delivery Information: Gestational Age at Delivery, Newborn's Delivery Information: Birth Date and Time, Pregnancy Information: Estimated Date of Delivery, Pregnancy Information: Fetal Presentation, Pregnancy Information: Gestational Age, Pregnancy Information: Gravidity, Pregnancy Information: Parity, Pregnancy Information: Pregnancy Outcomes, Pregnancy Information: Preterm Births, Pregnancy Information: Term Births, Pregnancy Information: Delivery Date and Time

Because this profile is derived directly or indirectly from US Core, systems are also expected to support the Must Support and Additional USCDI requirements specified by the US Core profile this profile inherits from. For more information about those requirements, refer to the US Core Simple Observation Profile. The Formal Views section also provides the formal summary, definitions, terminology requirements, and mandatory element requirements.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreSimpleObservationProfile(9.0.0) assessment observation
Constraints: obs-6, obs-7
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code (USCDI+ Quality) registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown
Binding: ObservationStatus (required): Codes providing the status of an observation.
.... category:us-core S 0..* CodeableConcept (USCDI+ Quality) US Core classification of type of observation
Binding: US Core Simple Observation Category (required): Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
Additional BindingsPurpose
US Core Screening Assessment Observation Category Min Binding

... code SΣ 1..1 CodeableConcept (USCDI+ Quality) Type of observation (code / type)
Binding: LOINCCodes (preferred): This value set specifies the type of observation
... subject SΣ 1..1 Reference(US Quality Core Patient) Who and/or what the observation is about
... effective[x] SΣ 0..1 (USCDI+ Quality) Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime S
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... performer SΣ 0..* Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) (USCDI+ Quality) Who is responsible for the observation
... value[x] SΣC 0..1 (USCDI+ Quality) Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity S
.... valueCodeableConcept CodeableConcept S
.... valueString string S
.... valueBoolean boolean S
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... derivedFrom Σ 0..* Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(9.0.0) | Media | MolecularSequence) US Core Profiles or other resource the observation is made from

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base required US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base preferred LOINC Codes 📦4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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-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()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation 0..* USCoreSimpleObservationProfile(9.0.0) assessment observation
... status 1..1 code (USCDI+ Quality) registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown
... category 1..* CodeableConcept (USCDI+ Quality) Classification of type of observation
... Slices for category Content/Rules for all slices
.... category:us-core S 0..* CodeableConcept (USCDI+ Quality) US Core classification of type of observation
... subject 1..1 Reference(US Quality Core Patient) Who and/or what the observation is about
... effective[x] 0..1 dateTime, Period, Timing, instant (USCDI+ Quality) Clinically relevant time/time-period for observation
... performer 0..* Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) (USCDI+ Quality) Who is responsible for the observation
... value[x] 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period (USCDI+ Quality) Actual result
Slice: Unordered, Open by type:$this
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... derivedFrom 0..* Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(9.0.0) | Media | MolecularSequence) US Core Profiles or other resource the observation is made from

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Observation.code Base preferred LOINC Codes 📦4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreSimpleObservationProfile(9.0.0) assessment observation
Constraints: obs-6, obs-7
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code (USCDI+ Quality) registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown
Binding: ObservationStatus (required): Codes providing the status of an observation.
... Slices for category S 1..* CodeableConcept (USCDI+ Quality) Classification of type of observation
Slice: Unordered, Open by value:$this
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.
.... category:us-core S 0..* CodeableConcept (USCDI+ Quality) US Core classification of type of observation
Binding: US Core Simple Observation Category (required): Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
Additional BindingsPurpose
US Core Screening Assessment Observation Category Min Binding

... code SΣ 1..1 CodeableConcept (USCDI+ Quality) Type of observation (code / type)
Binding: LOINCCodes (preferred): This value set specifies the type of observation
... subject SΣ 1..1 Reference(US Quality Core Patient) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣ 0..1 (USCDI+ Quality) Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime S
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... issued Σ 0..1 instant Date/Time this version was made available
... performer SΣ 0..* Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) (USCDI+ Quality) Who is responsible for the observation
... value[x] SΣC 0..1 (USCDI+ Quality) Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity S
.... valueCodeableConcept CodeableConcept S
.... valueString string S
.... valueBoolean boolean S
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
.... high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
... derivedFrom Σ 0..* Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(9.0.0) | Media | MolecularSequence) US Core Profiles or other resource the observation is made from
... component Σ 0..* BackboneElement Component results
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.
.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
.... interpretation 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base required US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base preferred LOINC Codes 📦4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.
Observation.bodySite Base example SNOMED CT Body Structures 📍4.0.1 FHIR Std.
Observation.method Base example Observation Methods 📍4.0.1 FHIR Std.
Observation.referenceRange.​type Base preferred Observation Reference Range Meaning Codes 📍4.0.1 FHIR Std.
Observation.referenceRange.​appliesTo Base example Observation Reference Range Applies To Codes 📍4.0.1 FHIR Std.
Observation.component.​code Base example LOINC Codes 📍4.0.1 FHIR Std.
Observation.component.​dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.component.​interpretation Base extensible Observation Interpretation Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreSimpleObservationProfile(9.0.0) assessment observation
Constraints: obs-6, obs-7
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code (USCDI+ Quality) registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown
Binding: ObservationStatus (required): Codes providing the status of an observation.
.... category:us-core S 0..* CodeableConcept (USCDI+ Quality) US Core classification of type of observation
Binding: US Core Simple Observation Category (required): Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
Additional BindingsPurpose
US Core Screening Assessment Observation Category Min Binding

... code SΣ 1..1 CodeableConcept (USCDI+ Quality) Type of observation (code / type)
Binding: LOINCCodes (preferred): This value set specifies the type of observation
... subject SΣ 1..1 Reference(US Quality Core Patient) Who and/or what the observation is about
... effective[x] SΣ 0..1 (USCDI+ Quality) Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime S
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... performer SΣ 0..* Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) (USCDI+ Quality) Who is responsible for the observation
... value[x] SΣC 0..1 (USCDI+ Quality) Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity S
.... valueCodeableConcept CodeableConcept S
.... valueString string S
.... valueBoolean boolean S
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... derivedFrom Σ 0..* Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(9.0.0) | Media | MolecularSequence) US Core Profiles or other resource the observation is made from

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base required US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base preferred LOINC Codes 📦4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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-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()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation 0..* USCoreSimpleObservationProfile(9.0.0) assessment observation
... status 1..1 code (USCDI+ Quality) registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown
... category 1..* CodeableConcept (USCDI+ Quality) Classification of type of observation
... Slices for category Content/Rules for all slices
.... category:us-core S 0..* CodeableConcept (USCDI+ Quality) US Core classification of type of observation
... subject 1..1 Reference(US Quality Core Patient) Who and/or what the observation is about
... effective[x] 0..1 dateTime, Period, Timing, instant (USCDI+ Quality) Clinically relevant time/time-period for observation
... performer 0..* Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) (USCDI+ Quality) Who is responsible for the observation
... value[x] 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period (USCDI+ Quality) Actual result
Slice: Unordered, Open by type:$this
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... derivedFrom 0..* Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(9.0.0) | Media | MolecularSequence) US Core Profiles or other resource the observation is made from

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Observation.code Base preferred LOINC Codes 📦4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreSimpleObservationProfile(9.0.0) assessment observation
Constraints: obs-6, obs-7
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code (USCDI+ Quality) registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown
Binding: ObservationStatus (required): Codes providing the status of an observation.
... Slices for category S 1..* CodeableConcept (USCDI+ Quality) Classification of type of observation
Slice: Unordered, Open by value:$this
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.
.... category:us-core S 0..* CodeableConcept (USCDI+ Quality) US Core classification of type of observation
Binding: US Core Simple Observation Category (required): Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
Additional BindingsPurpose
US Core Screening Assessment Observation Category Min Binding

... code SΣ 1..1 CodeableConcept (USCDI+ Quality) Type of observation (code / type)
Binding: LOINCCodes (preferred): This value set specifies the type of observation
... subject SΣ 1..1 Reference(US Quality Core Patient) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣ 0..1 (USCDI+ Quality) Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime S
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... issued Σ 0..1 instant Date/Time this version was made available
... performer SΣ 0..* Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) (USCDI+ Quality) Who is responsible for the observation
... value[x] SΣC 0..1 (USCDI+ Quality) Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity S
.... valueCodeableConcept CodeableConcept S
.... valueString string S
.... valueBoolean boolean S
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
.... high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
... derivedFrom Σ 0..* Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(9.0.0) | Media | MolecularSequence) US Core Profiles or other resource the observation is made from
... component Σ 0..* BackboneElement Component results
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.
.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
.... interpretation 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base required US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base preferred LOINC Codes 📦4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.
Observation.bodySite Base example SNOMED CT Body Structures 📍4.0.1 FHIR Std.
Observation.method Base example Observation Methods 📍4.0.1 FHIR Std.
Observation.referenceRange.​type Base preferred Observation Reference Range Meaning Codes 📍4.0.1 FHIR Std.
Observation.referenceRange.​appliesTo Base example Observation Reference Range Applies To Codes 📍4.0.1 FHIR Std.
Observation.component.​code Base example LOINC Codes 📍4.0.1 FHIR Std.
Observation.component.​dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.component.​interpretation Base extensible Observation Interpretation Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Element Conformance Indicators by Profile Layer

Badges identify the profile layer where each conformance indicator is first introduced. Indicators introduced in an earlier layer remain applicable in later derived profiles.

Element conformance indicators organized by the profile layer where they are first introduced
Profile element FHIR US Core US Quality Core
status Mandatory Must Support USCDI+ Quality
category Mandatory Must Support USCDI+ Quality
category:us-core Additional USCDI Must Support USCDI+ Quality
code Mandatory Must Support USCDI+ Quality
subject Mandatory Must Support
effective[x] Must Support USCDI+ Quality
performer Must Support USCDI+ Quality
value[x] Must Support USCDI+ Quality
derivedFrom Additional USCDI
component.code Mandatory

Cardinality note: “Mandatory” means the element has a minimum cardinality greater than zero. For nested elements, the cardinality indicator applies when the containing element is present.

Mandatory US Quality Core Server Search Parameters

The searches below are the focused set identified by US Quality Core as needed to retrieve USCDI+ Quality data for quality measurement and reporting. See the US Core FHIR RESTful Search API Requirements for detailed information on requirements by search parameter type.

Because this profile derives directly or indirectly from US Core, servers SHALL also support all mandatory searches described in the US Core Server CapabilityStatement requirements for Observation. When possible, this guide reuses mandatory searches from US Core and notes them with the EXISTING US CORE REQUIREMENT flag. While US Quality Core may restate US Core requirements to highlight searches directly relevant to USCDI+ Quality data access, US Core requirements not restated here remain applicable.

See the US Quality Core Server CapabilityStatement for complete requirements for the underlying Observation resource and Search Requirement Selection for how this focused set was selected.

Servers supporting this profile SHALL support the following search parameters and search parameter combinations:

  1. SHALL support searching for all Observation resources for a patient using the combination of the patient, category, and status search parameters.

    • Including optional support for OR search on category (e.g.category={system|}[search_code],{system|}[search_code],...).

    • Including support for OR search on status (e.g.status=[status],[status],...).

    GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&status=[status]

    Example:

    GET [base]/Observation?patient=Patient/example&category=http://terminology.hl7.org/CodeSystem/observation-category|exam&status=final

    Implementation Notes: Fetches a bundle of US Quality Core Simple Observation resources matching the specified search criteria. See how to search by reference and how to search by token.

    Rationale for inclusion: Supports patient-scoped retrieval of Observation resources filtered by category and status for status-sensitive quality workflows.

  2. SHALL support searching for all Observation resources for a patient using the combination of the patient and category search parameters. EXISTING US CORE REQUIREMENT

    • Including optional support for OR search on category (e.g.category={system|}[search_code],{system|}[search_code],...).

    GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]

    Example:

    GET [base]/Observation?patient=Patient/example&category=http://terminology.hl7.org/CodeSystem/observation-category|exam

    Implementation Notes: Fetches a bundle of US Quality Core Simple Observation resources matching the specified search criteria. See how to search by reference and how to search by token.

    Rationale for inclusion: Supports patient-scoped retrieval of Observation resources filtered by category for USCDI+ Quality workflows.

  3. SHALL support searching for all Observation resources for a patient using the combination of the patient, category, and date search parameters. EXISTING US CORE REQUIREMENT

    • Including optional support for OR search on category (e.g.category={system|}[search_code],{system|}[search_code],...).

    • Including optional support for AND search on date (e.g.date=[date]&date=[date]&...).

    • Including support for these date comparators: "gt", "lt", "ge", "le".

    GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&date={gt|lt|ge|le}[dateTime]

    Example:

    GET [base]/Observation?patient=Patient/example&category=http://terminology.hl7.org/CodeSystem/observation-category|exam&date=ge2020-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of US Quality Core Simple Observation resources matching the specified search criteria. See how to search by reference, how to search by token, and how to search by date.

    Rationale for inclusion: Supports patient-scoped retrieval of Observation resources filtered by category and date so quality workflows can constrain results to relevant reporting periods.

  4. SHALL support searching for all Observation resources for a patient using the combination of the patient and code search parameters. EXISTING US CORE REQUIREMENT

    • Including optional support for OR search on code (e.g.code={system|}[search_code],{system|}[search_code],...).

    GET [base]/Observation?patient={Patient/}[id]&code={system|}[search_code]

    Example:

    GET [base]/Observation?patient=Patient/example&code=http://loinc.org|8884-9

    Implementation Notes: Fetches a bundle of US Quality Core Simple Observation resources matching the specified search criteria. See how to search by reference and how to search by token.

    Rationale for inclusion: Supports patient-scoped retrieval of Observation resources filtered by code for USCDI+ Quality workflows.