臺灣核心實作指引(TW Core IG)
0.3.1 - Ci-Build Trial Use

臺灣核心實作指引(TW Core IG), published by 衛生福利部. This guide is not an authorized publication; it is the continuous build for version 0.3.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cctwFHIRterm/MOHW_TWCoreIG_Build/ and changes regularly. See the Directory of published versions

Resource Profile: TW Core Observation Heart Rate

Official URL: https://twcore.mohw.gov.tw/ig/twcore/StructureDefinition/Observation-heart-rate-twcore Version: 0.3.1
Active as of 2024-12-02 Computable Name: TWCoreObservationHeartRate

此臺灣核心-心率（TW Core Observation Heart Rate） Profile說明本IG如何進一步定義臺灣核心-生命體徵（TW Core Observation Vital Signs） Profile以呈現心率資料。

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-heartrate FHIR Heart Rate Profile
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... basedOn Σ 0..* Reference(TW Core CarePlan | DeviceRequest | ImmunizationRecommendation | TW Core MedicationRequest | NutritionOrder | TW Core ServiceRequest) Fulfills plan, proposal or order
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code S 1..1 CodeableConceptTW 概念（Concept）— 參照一個專門術語或只是文字表述
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:HeartRateCode Σ 1..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8867-4
... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... encounter Σ 0..1 Reference(TW Core Encounter) Healthcare event during which this observation is made
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... performer Σ 0..* Reference(TW Core Practitioner | TW Core Organization | TW Core Patient | TW Core PractitionerRole | TW Core CareTeam) Who is responsible for the observation
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... value SΣ 1..1 decimal Numerical value (with implicit precision)
..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

..... unit SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Fixed Value: /min
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... specimen 0..1 Reference(TW Core Specimen) Specimen used for this observation
... hasMember Σ 0..* Reference(TW Core Observation Vital Signs | TW Core QuestionnaireResponse | MolecularSequence) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(TW Core DocumentReference | TW Core ImagingStudy | TW Core Media | TW Core QuestionnaireResponse | TW Core Observation Vital Signs | MolecularSequence) Related measurements the observation is made from
... component SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: $this is dateTime implies $this.toString().length() >= 10
vs-2errorObservationIf there is no component or hasMember element then either a value[x] or a data absent reason must be present.
: (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-heartrate FHIR Heart Rate Profile
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... 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
... 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(TW Core CarePlan | DeviceRequest | ImmunizationRecommendation | TW Core MedicationRequest | NutritionOrder | TW Core ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | TW Core MedicationDispense | TW Core MedicationStatement | TW Core Procedure | TW Core Immunization | TW Core ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
... code S 1..1 CodeableConceptTW 概念（Concept）— 參照一個專門術語或只是文字表述
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:HeartRateCode Σ 1..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8867-4
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(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(TW Core Encounter) Healthcare event during which this observation is made
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(TW Core Practitioner | TW Core Organization | TW Core Patient | TW Core PractitionerRole | TW Core CareTeam) Who is responsible for the observation
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣ 1..1 decimal Numerical value (with implicit precision)
..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

..... unit SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Fixed Value: /min
... dataAbsentReason SC 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(TW Core Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
obs-3: Must have at least a low or a high or text
.... 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 Low Range, if relevant
.... high C 0..1 SimpleQuantity 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(TW Core Observation Vital Signs | TW Core QuestionnaireResponse | MolecularSequence) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(TW Core DocumentReference | TW Core ImagingStudy | TW Core Media | TW Core QuestionnaireResponse | TW Core Observation Vital Signs | MolecularSequence) Related measurements the observation is made from
... component SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... 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 SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 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

PathConformanceValueSetURI
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard
Observation.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard
Observation.methodexampleObservationMethods
http://hl7.org/fhir/ValueSet/observation-methods
from the FHIR Standard
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
http://hl7.org/fhir/ValueSet/referencerange-meaning
from the FHIR Standard
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
http://hl7.org/fhir/ValueSet/referencerange-appliesto
from the FHIR Standard
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-3errorObservation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: $this is dateTime implies $this.toString().length() >= 10
vs-2errorObservationIf there is no component or hasMember element then either a value[x] or a data absent reason must be present.
: (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

This structure is derived from observation-heartrate

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

Differential View

This structure is derived from observation-heartrate

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-heartrate FHIR Heart Rate Profile
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... basedOn Σ 0..* Reference(TW Core CarePlan | DeviceRequest | ImmunizationRecommendation | TW Core MedicationRequest | NutritionOrder | TW Core ServiceRequest) Fulfills plan, proposal or order
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code S 1..1 CodeableConceptTW 概念（Concept）— 參照一個專門術語或只是文字表述
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:HeartRateCode Σ 1..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8867-4
... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... encounter Σ 0..1 Reference(TW Core Encounter) Healthcare event during which this observation is made
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... performer Σ 0..* Reference(TW Core Practitioner | TW Core Organization | TW Core Patient | TW Core PractitionerRole | TW Core CareTeam) Who is responsible for the observation
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... value SΣ 1..1 decimal Numerical value (with implicit precision)
..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

..... unit SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Fixed Value: /min
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... specimen 0..1 Reference(TW Core Specimen) Specimen used for this observation
... hasMember Σ 0..* Reference(TW Core Observation Vital Signs | TW Core QuestionnaireResponse | MolecularSequence) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(TW Core DocumentReference | TW Core ImagingStudy | TW Core Media | TW Core QuestionnaireResponse | TW Core Observation Vital Signs | MolecularSequence) Related measurements the observation is made from
... component SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: $this is dateTime implies $this.toString().length() >= 10
vs-2errorObservationIf there is no component or hasMember element then either a value[x] or a data absent reason must be present.
: (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-heartrate FHIR Heart Rate Profile
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... 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
... 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(TW Core CarePlan | DeviceRequest | ImmunizationRecommendation | TW Core MedicationRequest | NutritionOrder | TW Core ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | TW Core MedicationDispense | TW Core MedicationStatement | TW Core Procedure | TW Core Immunization | TW Core ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
... code S 1..1 CodeableConceptTW 概念（Concept）— 參照一個專門術語或只是文字表述
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:HeartRateCode Σ 1..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8867-4
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(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(TW Core Encounter) Healthcare event during which this observation is made
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(TW Core Practitioner | TW Core Organization | TW Core Patient | TW Core PractitionerRole | TW Core CareTeam) Who is responsible for the observation
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣ 1..1 decimal Numerical value (with implicit precision)
..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

..... unit SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Fixed Value: /min
... dataAbsentReason SC 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(TW Core Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
obs-3: Must have at least a low or a high or text
.... 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 Low Range, if relevant
.... high C 0..1 SimpleQuantity 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(TW Core Observation Vital Signs | TW Core QuestionnaireResponse | MolecularSequence) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(TW Core DocumentReference | TW Core ImagingStudy | TW Core Media | TW Core QuestionnaireResponse | TW Core Observation Vital Signs | MolecularSequence) Related measurements the observation is made from
... component SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... 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 SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 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

PathConformanceValueSetURI
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard
Observation.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard
Observation.methodexampleObservationMethods
http://hl7.org/fhir/ValueSet/observation-methods
from the FHIR Standard
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
http://hl7.org/fhir/ValueSet/referencerange-meaning
from the FHIR Standard
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
http://hl7.org/fhir/ValueSet/referencerange-appliesto
from the FHIR Standard
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-3errorObservation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: $this is dateTime implies $this.toString().length() >= 10
vs-2errorObservationIf there is no component or hasMember element then either a value[x] or a data absent reason must be present.
: (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

This structure is derived from observation-heartrate

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

 

Other representations of profile: CSV, Excel, Schematron

Notes:

以下概述了此Profile所需的RESTful FHIR互動功能。有關TW Core IG支援的RESTful互動功能的完整清單，請參閱TW Core Server能力聲明。

必須支援以下查詢參數：

  1. 必須（SHALL） 支援透過查詢參數 patient 及 category 查詢所有Observation：
    (如何透過reference查詢)
    (如何透過token查詢)
    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

    例子：
    (1) GET [base]/Observation?patient=Patient/pat-example&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

  2. 必須（SHALL） 支援透過查詢參數 patient 及 code 查詢所有Observation：
    (如何透過reference查詢)
    (如何透過token查詢)
    GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

    例子：
    (1) GET [base]/Observation?patient=Patient/pat-example&code=http://loinc.org|8867-4

  3. 必須（SHALL） 支援透過查詢參數 patient 、 category 及 date 查詢所有Observation：
    (如何透過reference查詢)
    (如何透過token查詢)
    (如何透過date查詢)
    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    例子：
    (1) GET [base]/Observation?patient=Patient/pat-example&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date=ge2020-01-01T00:00:00Z

建議應該支援以下查詢參數：

  1. 建議應該（SHOULD） 支援透過查詢參數 patient 、 category 及 status 查詢所有Observation：
    (如何透過reference查詢)
    (如何透過token查詢)
    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&status={system|}[code]{,{system|}[code],...}

    例子：
    (1) GET [base]/Observation?patient=Patient/pat-example&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status=final

  2. 建議應該（SHOULD） 支援透過查詢參數 patient 、 category 及 _lastUpdated 查詢所有Observation：
    (如何透過reference查詢)
    (如何透過token查詢)
    (如何透過date查詢)
    GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&_lastUpdated={gt|lt|ge|le}[date]{&_lastUpdated={gt|lt|ge|le}[date]&...}

    例子：
    (1) GET [base]/Observation?patient=Patient/pat-example&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&_lastUpdated=ge2024-01-01T00:00:00Z

  3. 支援透過查詢參數 patient 、 code 及 date 查詢所有Observation：
    (如何透過reference查詢)
    (如何透過token查詢)
    (如何透過date查詢)
    GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    例子：
    (1) GET [base]/Observation?patient=Patient/pat-example&code=http://loinc.org|8867-4&date=ge2020-01-01T00:00:00Z