This observation indicates one or more issues the PHD had attempting to take a measurement, for example, finger poorly positioned, cannot get a sufficiently strong signal, etc.

This example comes from a pulse oximeter when the sensor mechanism is having a set of difficulties. The set of difficulties are reported by setting a bit respresenting the issue in an integer. Since HL7 does not support this kind of measurement, the bit settings are converted to codes for FHIR using the ASN1ToHL7 code system. In this case the codes have value 150604.x where x is the Mder bit representing a given condition and '150604' is the MDC code describing the measurement. '150604' is a device and sensor status measurement. In this case, 5 of the 16 possible flags are set. All of the bits in this measurement are events thus they are only required to be reported when set (values are "Y" in FHIR).

The source of the ASN1 names comes from the IEEE 11073-11404 (pulse Oximeter) specialization standard where this measurement is described in detail.

The PHD does not send time stamps with its measurements therefore the time stamp is the time of reception by the PHG and there is no coincident time stamp Observation.

Note there is no logical id in this resource as this resource is being uploaded to the server in a create operation. The server will create the logical id and return it to the sender in the response. There is also no reference to the coincident time stamp since this observation is generated by a device that is streaming data and reporting no time stamp. The time stamp is taken to be the time of reception by the gateway.

Generated Narrative: Observation bits-observation

Observation Gateway Device: Device: identifier = IEEE 11073 System Identifier,Bluetooth MAC address,Ethernet MAC address; type = MDC_MOC_VMS_MDS_AHD

status: Final

category: PHD generated Observation

code: MDC_PULS_OXIM_DEV_STATUS: Measuring process issues

subject: Sisansarah Lorianthah Piggy (no stated gender), DoB Unknown ( Medical record number)

effective: 2018-11-11 19:07:48-0500

device: Device: identifier = IEEE 11073 System Identifier,Bluetooth MAC address; manufacturer = Nonin_Medical_Inc.; serialNumber = 501900083; modelNumber = Model 3230; type = MDC_MOC_VMS_MDS_SIMP

component

code: sensor-displaced

value: Sensor is incorrectly placed on user

component

code: signal-pulse-questionable

value: Questionable pulse detected

component

code: signal-low-perfusion

value: Signal experiencing low perfusion

component

code: signal-poor

value: Signal is poor

component

code: signal-inadequate

value: Signal is inadequate