Generated Narrative: StructureDefinition PhdCoincidentTimeStampObservation Last updated: 2017-12-14 09:41:34-0500 Name Flags Card. Type Description & Constraints Observation 0..* Observation Measurements and simple assertions #xD; status 1..1 code registered | in-process | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained Required Pattern: final #xD; code #xD; Slices for coding 1..* Coding Code defined by a terminology system Slice: Unordered, Open by value:$this #xD; coding:MDCType 1..1 Coding The type of time clock used by the PHD Binding: MDC Clock Types (required): MDC codes for PHD clock types #xD; subject 1..1 Reference(PhdDevice) Reference to the PHD device for which the coincident timestamp measurement is reported #xD; reference 1..1 string Literal reference, Relative, internal or absolute URL #xD; focus 0..0 No focus in PHD. The coincident timestamp is not associated with a focus. #xD; effective[x] 0..1 dateTime, Period, Timing, instant The current time of the PHG at the current time of the PHD. Absent if PHD is better synchronized #xD; value[x] 0..1 The current time of the PHD as a wallclock time (dateTime), relative time (Quantity), or if a time fault a dataAbsentReason #xD; valueQuantity Quantity #xD; valueDateTime dateTime #xD; dataAbsentReason #xD; Slices for coding 0..* Coding Code defined by a terminology system Slice: Unordered, Open by value:$this #xD; coding:TimeFault 0..1 Coding Time Fault: The PHD has a time fault Required Pattern: At least the following #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/data-absent-reason #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: unknown #xD; specimen 0..0 No specimen in PHD. The coincident timestamp is not associated with a specimen. #xD; device 1..1 Reference(PhgDevice) A reference to the device that generates the measurements or the device settings for the device #xD; reference 1..1 string Reference to the PHG device responsible for the coincident timestamp measurement #xD; hasMember 0..0 No reference to a group observation in PHD. The coincident timestamp is not part of a group observation. #xD; derivedFrom 0..0 No reference to a source observation in PHD. The coincident timestamp is not derived from another observation. #xD; Slices for component 0..* BackboneElement Component results Slice: Unordered, Open by value:code #xD; component:clockSyncMethod 0..1 BackboneElement Clock Synchronization Method: The method used to synchronize the clock. #xD; code 1..1 CodeableConcept Type of component observation (code / type) Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101 #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 68220 #xD; Slices for value[x] 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period, Attachment Actual component result Slice: Unordered, Open by type:$this #xD; Slices for value[x] Content/Rules for all slices #xD; value[x]:valueCodeableConcept 0..1 CodeableConcept The clock synchronization method last used by the PHD/PHG to synchronize the clock of the PHD Binding: MDC Time Synchronization Methods (<a href="http://hl7.org/fhir/6.0.0-ballot5/terminologies.html#extensible" title="To be conformant, the concept in this element SHALL be from the specified value set if any of the codes within the value set can apply to the concept being communicated. If the value set does not cover the concept (based on human review), alternate codings (or, data type allowing, text) may be included instead." class="binding">extensible) #xD; dataAbsentReason 0..0 Why the component result value is missing #xD; Documentation for this format
Observations containing a coincident timestamp.
The PhdCoincidentTimeStampObservation reports the current time of the PHD sensor at the current time of the PHG.
Used to record the correction the PHG applied to the PHD measurement timestamps (if any) and to be able to recover the original timestamps reported by the PHD should that be needed.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()
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()
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Observation.dataAbsentReason SHALL only be present if Observation.value[x] is not present
dataAbsentReason.empty() or value.empty()
If Observation.component.code is the same as Observation.code, then Observation.value SHALL NOT be present (the Observation.component.value[x] holds the value).
value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
Observation.component.dataAbsentReason SHALL only be present if Observation.component.value[x] is not present
component.empty() or component.where(dataAbsentReason.exists()).all(value.empty())
if organizer exists and organizer = true, then value[x], dataAbsentReason and component SHALL NOT be present
(organizer.exists() and organizer.allTrue()) implies (value.empty() and dataAbsentReason.empty() and component.empty())
All observations SHOULD have a performer
Entity, Role, or Act,Observation[classCode=OBS, moodCode=EVN]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resource id depends on the given use case.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the [additionalImplicitRules](https://build.fhir.org/ig/HL7/fhir-extensions/StructureDefinition-additionalImplicitRules.html) extension.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. Contained resources may be a resource type defined in the FHIR specification, or an [additional resource](http://build.fhir.org/resource.html#additional).
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://build.fhir.org/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
A unique identifier assigned to this observation.
Allows observations to be distinguished and referenced.
OBX-21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 3) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4.
A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
Identifies the observation(s) that triggered the performance of this observation.
All FHIR elements must have a @value or children or both
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Reference to the triggering observation.
The type of trigger. Reflex | Repeat | Re-run.
Reason that the observation was triggered
Provides the reason why this observation was performed as a result of the observation(s) referenced.
A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.
To link an Observation to an Encounter use `encounter`. See the [Notes](http://build.fhir.org/observation.html#obsgrouping) below for guidance on referencing another Observation.
registered | in-process | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
The status of the result value. Always 'final'
Need to track the status of individual results. Some results are finalized before the whole report is finalized.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Codes providing the status of an observation.
OBX-11 Map FHIR Observation.status to OBX-11. If FHIR carries Observation.dataAbsentReason = ‘not-asked’, set OBX-11 to the v2 as ‘N’. If there is alternate-code extension on Observation.status with code ‘X’, set OBX-11 as ‘X’.
status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
Captures the reason for the current state of the Observation.
This is generally only used for "exception" statuses such as "not-done", "suspended" or "cancelled".
Codes identifying the reason for the current state of an observation.
A code that classifies the general type of observation being made.
In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.
Used for filtering what observations are retrieved and displayed.
Codes for high level observation categories.
.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
Describes what was observed. Sometimes this is called the observation "name".
*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation. All codings in Observation.code are expected to be sufficiently precise to allow a user with the code and value to be able to understand the value - though not all codes will necessarily convey the same level of detail. Codings in Observation.category SHOULD be concepts that are too broad to be able to understand the meaning of the Observation.value without also having an Observation.code. See [Interoperability Issues using code value pairs in FHIR](http://build.fhir.org/observation.html#code-interop) for additional information.
Knowing what kind of observation is being made is essential to understanding the observation.
Codes identifying names of simple observations.
< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Reference to the PHD device for which the coincident timestamp measurement is reported
Reference to the PHD device for which the coincident timestamp measurement is reported. This element will point to a Device resource following the Phd Device Profile.
One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated. The subject of an Observation may in some cases be a procedure. This supports the regulatory inspection use case where observations are captured during inspections of a procedure that is being performed (independent of any particular patient or whether patient related at all).
Observations have no value if you don't know who or what they're about.
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient") - must be a resource in resources
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). This element only allows for a single identifier. In the case where additional identifiers are required, use the [additional identifier](https://build.fhir.org/ig/HL7/fhir-extensions/StructureDefinition-additionalIdentifier.html) extension.
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
No focus in PHD. The coincident timestamp is not associated with a focus.
This element is not used in PHD as the coincident timestamp is not associated with a focus.
Examples demonstrating the use of subject and focus in an Observation: - A parent is trained to change their child's tracheostomy tube. The child is the subject, and the parent is the focus. - A fetal heart rate recorded in a mother's record. The mother is the subject, and the fetus is the focus. - Features of a body structure, such as a tumor. The patient is the subject, and the specific body structure is the focus. - Metrics captured from a medical device. The patient-attached device is the subject, the specific device metric is the focus, and the observing device itself is referenced in .device.
This element is labeled as a modifier because it changes who is the target of the observation. See the use cases in the definition.
This observation organizes/groups a set of sub-observations
This observation serves as an organizer or grouper for a set of (one or more) sub-observations.
An observation that is an organizer/grouper does not have a value (or dataAbsentReason) of its own - all values are included in the sub-observations. The sub-observations are linked using hasMember element references (in some instances there may be no hasMember references, as it is possible that the organizer/grouper observation may be created first, and the sub-observations are not created until a later time). An organizer/grouper observation also does not contain any components.
Healthcare event during which this observation is made. If you need to place the observation within one or more episodes of care, use the workflow-episodeOfCare extension
The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
For some observations it may be important to know the link between an observation and a particular encounter.
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
The current time of the PHG at the current time of the PHD. Absent if PHD is better synchronized
The time of the PHG at the time the current time of the PHD is ascertained.
This element is absent if the PHD has superior time synchronization relative to the PHG. When this element is absent it indicates that the PHG reported the measurement timestamps of the PHD without modification.
Knowing when an observation was deemed true is important to its relevance as well as determining trends.
OBX-14 (If Observation carries the AnalysisDateTime extension, then map the extension to OBX-19)
Date/Time this version was made available
The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.
For Observations that don't require review and verification, it may be the same as the [`lastUpdated` ](http://build.fhir.org/resource-definitions.html#Meta.lastUpdated) time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn't require the new version to be reviewed and verified again.
OBR-22 (or MSH-7), or perhaps OBX-19 (depends on who observation made)
Who was responsible for asserting the observed value as "true".
Group is only allowed in the circumstance where the group represents a family or a household, and should not represent groups of Practitioners where other more specific resources can be used instead.
May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
OBX-15, OBX-16, OBX-23, OBX-24, OBX-25. Person/role → OBX-16 (Responsible Observer). If conveying performing org and medical director: use OBX-25 (XCN) for the director with role code “MDIR” (system v2-0912), and OBX-23/24 for org name/address; if there is no director, OBX-23/24 carry the org. OBX-15 is available for producer id (identifier for the producer).
The current time of the PHD as a wallclock time (dateTime), relative time (Quantity), or if a time fault a dataAbsentReason
The current time of the PHD. It will be either a `valueDateTime` if a wallclock time or a `valueQuantity` if a relative time or a `dataAbsentReason` if there is a time fault. The relative time is expressed in microseconds
- An observation may have: 1. a single value here 1. both a value and a set of related or component values 1. only a set of related or component values. - If a value is present, the datatype for this element should be determined by the `code`. - *CodeableConcept* with just a text would be used instead of a string if the field was usually coded, or if the type associated with the `code` defines a coded value. - *Attachment* is used if the observation result value is a binary file such as an image. If the observation result value is derived from the binary file (for example 'X' detected and here is the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`. - For additional guidance, see the [Notes section](http://build.fhir.org/observation.html#notes) below. - See [Interoperability Issues using code value pairs in FHIR](http://build.fhir.org/observation.html#code-interop) for additional information.
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Provides a reason why the expected value in the element Observation.value[x] is missing.
Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed.
For many results it is necessary to handle exceptional values in measurements.
Codes specifying why the result (`Observation.value[x]`) is missing.
OBX-32, OBX-11. Map Observation.dataAbsentReason to OBX-32 (Observation Value Absent Reason). Additionally, when dataAbsentReason.code = 'not-asked', also set OBX-11 = 'N'.
This element is populated when the PHD has a time fault and the current time of the PHD cannot be obtained.
A categorical assessment of an observation value. For example, high, low, normal.
Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Codes identifying interpretations of observations.
Context for understanding the observation
Contextual information that is relevant to understanding the observation value or interpretation. The referenced information may be concurrent or precede the observation.
This element provides essential contextual information that affects how the observation should be interpreted. For example, knowing that a patient is diabetic, fasting, or paraplegic may be critical to properly understanding lab results or other observations. Similarly, information about the timing, view, or imaging mode may be relevant to understanding an imaging measurement. This element is intended for interpretive context and not for conveying order, request, or fulfillment workflow information.
Codes identifying contextual factors that affect interpretation of observations.
Comments about the observation or the results.
May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.
Need to be able to provide free text additional information.
NTE-3 (partner NTE to OBX, or sometimes another (child?) OBX)
DEPRECATED: This element is deprecated. Use bodyStructure instead. Indicates the site on the subject's body where the observation was made (i.e. the target site).
DEPRECATED: Use bodyStructure instead. Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.
Indicates the body structure on the subject's body where the observation was made (i.e. the target site).
Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. Use this element instead of the deprecated bodySite element.
Indicates the mechanism used to perform the observation.
Only used if not implicit in code for Observation.code.
In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
No specimen in PHD. The coincident timestamp is not associated with a specimen.
This element is not used in PHD as the coincident timestamp is not associated with a specimen.
SHOULD be used when the observation is performed on a specimen. The type of specimen SHOULD be consistent with anything implied in the `Observation.code` value.
If Observation.specimen is a reference to Group, the group can only have specimens
(reference.resolve().exists() and reference.resolve() is Group) implies reference.resolve().member.entity.resolve().all($this is Specimen)
SPM segment (OBX-33 for Specimen.identifier mapping)
A reference to the device that generates the measurements or the device settings for the device
A reference to the device that generates the measurements or the device settings for the device.
This field will reference the PHG Device.
Reference to the PHG device responsible for the coincident timestamp measurement
Reference to the PHG device responsible for the coincident timestamp measurement. This element will point to a Device resource following the Phg Device Profile.
Device supporting generation of the measurement
A reference to additional devices, kits, or reagents (e.g., Test Kit, Calibration Kit, QC materials) used to support the generation of the measurement.
Type of device supporting the generation of the measurement.
Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.
Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Must have at least a low or a high or text
low.exists() or high.exists() or text.exists()
outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
The value of the low bound of the reference range.
When low.comparator is not populated (the low.comparator element was not available prior to FHIR R6), the low bound of the reference range endpoint is inclusive of the value (e.g., reference range is '>=5' - '<=9'). Alternatively, this can be specified explicitly by populating low.comparator = '>='. When the low bound of the reference range endpoint is intended to be exclusive of the value (e.g., reference range is '>5' - '<9'), this is specified with low.comparator = '>'. If the low bound is omitted, it is assumed to be meaningless (e.g., reference range is '<=2.3').
If low.comparator exists, it must be '>=' or '>'.
comparator.exists() implies (comparator = '>=' or comparator = '>')
The value of the high bound of the reference range.
When high.comparator is not populated (the high.comparator element was not available prior to FHIR R6), the high bound of the reference range endpoint is inclusive of the value (e.g., reference range is '>=5' - '<=9'). Alternatively, this can be specified explicitly by populating high.comparator = '<='. When the high bound of the reference range endpoint is intended to be exclusive of the value (e.g., reference range is '>5' - '<9'), this is specified with high.comparator = '<'. If the high bound is omitted, it is assumed to be meaningless (e.g., reference range is '>=2.3').
If high.comparator exists, it must be '<=' or '<'.
comparator.exists() implies (comparator = '<=' or comparator = '<')
The value of the normal value of the reference range.
Codes identifying the normal value of the observation.
Codes to indicate what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.
Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.
Code for the meaning of a reference range.
< 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.
This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
Need to be able to identify the target population for proper interpretation.
Codes identifying the population the reference range applies to.
The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.
Text based reference range in an observation
Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".
No reference to a group observation in PHD. The coincident timestamp is not part of a group observation.
This element is not used in PHD as the coincident timestamp is not part of a group observation.
When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://build.fhir.org/observation.html#obsgrouping) below. Note that a system may calculate results from [QuestionnaireResponse](http://build.fhir.org/questionnaireresponse.html) into a final score and represent the score as an Observation.
Relationships established by OBX-4 usage
No reference to a source observation in PHD. The coincident timestamp is not derived from another observation.
This element is not used in PHD as the coincident timestamp is not derived from another observation.
All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://build.fhir.org/observation.html#obsgrouping) below.
Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
For a discussion on the ways Observations can be assembled in groups together see [Notes](http://build.fhir.org/observation.html#notes) below.
Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, reference range, dataAbsentReason, and interpretation can differ between the components and are not inherited; these should be provided if appropriate.
Type of component observation (code / type)
Describes what was observed. Sometimes this is called the observation "code".
*All* code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
The information determined as a result of making the observation, if the information has a simple value.
Used when observation has a set of component observations: - An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). - If a value is present, the datatype for this element should be determined by the `code`. - *CodeableConcept* with just a text would be used instead of a string if the field was usually coded, or if the type associated with the `code` defines a coded value. - *Attachment* is used if the observation result value is a binary file such as an image. If the observation result value is derived from the binary file (for example 'X' detected and here is the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`. - If a value is present, the datatype for this element should be determined by the `code`. - *CodeableConcept* with just a text would be used instead of a string if the field was usually coded, or if the type associated with the `code` defines a coded value. - *Attachment* is used if the observation result value is a binary file such as an image. If the observation result value is derived from the binary file (for example 'X' detected and here is the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`. - For additional guidance, see the [Notes section](http://build.fhir.org/observation.html#notes) below.
363714003 |Interprets| < 441742003 |Evaluation finding|
Why the component result value is missing
Provides a reason why the expected value in the element Observation.component.value[x] is missing.
"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.
Provides guide for interpretation of component result value
Guidance on how to interpret the value by comparison to a normal or recommended range.
Clock Synchronization Method: The method used to synchronize the clock.
The method used to synchronize the clock of the PHD. This element is populated if the PHD supports clock synchronization.
Clock synchronization methods may include NTP, PTP, or other mechanisms.
The clock synchronization method last used by the PHD/PHG to synchronize the clock of the PHD