QI-Core Implementation Guide: STU 4 (v4.0.0 for FHIR 4.0.0)

QI-Core Implementation Guide, Clinical Quality Improvement WG - CI build for vesion 4.0.0). This version is based on the current content of https://github.com/cqframework/qi-core/ and changes regularly. See the Directory of published versions

D.4.1 StructureDefinition-qicore-observation

Introduction:

See the patterns page for implementation and usage patterns.

Examples:

Decreased Hemoglobin Example

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is:

http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation

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

This profile builds on Observation.

This profile was published on Wed Aug 22 00:00:00 UTC 2018 as a draft by Health Level Seven, Inc. - CQI WG.

Description of Profiles, Differentials, and Snapshots.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*
... id 0..1id
... observation-bodyPosition 0..1CodeableConceptThe body position during the observation
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
Binding: Body Position (preferred)
... observation-delta 0..1CodeableConceptQualitative change or trend in the measurement
URL: http://hl7.org/fhir/StructureDefinition/observation-delta
Binding: QICore Observation Delta Value Set Definition (example)
... basedOn 0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
... status S1..1code
... category S1..*CodeableConcept
... code S1..1CodeableConcept
... subject S1..1Reference(QICorePatient | QICoreDevice | QICoreLocation)
... encounter S0..1Reference(QICoreEncounter)
... effective[x] S0..1dateTime, Period, Timing, instant
... issued S0..1instant
... performer 0..*Reference(QICorePractitioner | QICoreOrganization | QICorePatient | QICoreRelatedPerson)
... value[x] S0..1Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, PeriodBinding: US Core Observation Value Codes (SNOMED-CT) (preferred)
... dataAbsentReason 0..1CodeableConcept
... interpretation S0..*CodeableConcept
... bodySite S0..1CodeableConcept
... method S0..1CodeableConcept
... specimen S0..1Reference(QICoreSpecimen)
... device 0..1Reference(QICoreDevice | DeviceMetric)
... referenceRange 0..*BackboneElement
.... low 0..1SimpleQuantity
.... high 0..1SimpleQuantity
... derivedFrom 0..*Reference(QICoreObservation | QuestionnaireResponse)
... component S0..*BackboneElement
.... code S1..1CodeableConcept
.... value[x] S0..1Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
.... dataAbsentReason S0..1CodeableConcept
.... interpretation S0..*CodeableConcept
.... referenceRange 0..*

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*Measurements and simple assertions
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... observation-bodyPosition I0..1CodeableConceptThe body position during the observation
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
... observation-delta I0..1CodeableConceptQualitative change or trend in the measurement
URL: http://hl7.org/fhir/StructureDefinition/observation-delta
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category S1..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)
... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINCCodes (example)
... subject SΣ1..1Reference(QICorePatient | QICoreDevice | QICoreLocation)Who and/or what the observation is about
... focus Σ0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter SΣ0..1Reference(QICoreEncounter)Healthcare event during which this observation is made
... effective[x] SΣ0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued SΣ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(QICorePractitioner | QICoreOrganization | QICorePatient | QICoreRelatedPerson)Who is responsible for the observation
... value[x] SΣI0..1Actual result
Binding: US Core Observation Value Codes (SNOMED-CT) (preferred)
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible)
... interpretation S0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
... note 0..*AnnotationComments about the observation
... bodySite S0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example)
... method S0..1CodeableConceptHow it was done
Binding: ObservationMethods (example)
... specimen S0..1Reference(QICoreSpecimen)Specimen used for this observation
... device 0..1Reference(QICoreDevice | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred)
.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom Σ0..*Reference(QICoreObservation | QuestionnaireResponse)Related measurements the observation is made from
... component SΣI0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example)
.... value[x] SΣ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible)
.... interpretation S0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*
... id 0..1id
... observation-bodyPosition 0..1CodeableConceptThe body position during the observation
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
Binding: Body Position (preferred)
... observation-delta 0..1CodeableConceptQualitative change or trend in the measurement
URL: http://hl7.org/fhir/StructureDefinition/observation-delta
Binding: QICore Observation Delta Value Set Definition (example)
... basedOn 0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
... status S1..1code
... category S1..*CodeableConcept
... code S1..1CodeableConcept
... subject S1..1Reference(QICorePatient | QICoreDevice | QICoreLocation)
... encounter S0..1Reference(QICoreEncounter)
... effective[x] S0..1dateTime, Period, Timing, instant
... issued S0..1instant
... performer 0..*Reference(QICorePractitioner | QICoreOrganization | QICorePatient | QICoreRelatedPerson)
... value[x] S0..1Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, PeriodBinding: US Core Observation Value Codes (SNOMED-CT) (preferred)
... dataAbsentReason 0..1CodeableConcept
... interpretation S0..*CodeableConcept
... bodySite S0..1CodeableConcept
... method S0..1CodeableConcept
... specimen S0..1Reference(QICoreSpecimen)
... device 0..1Reference(QICoreDevice | DeviceMetric)
... referenceRange 0..*BackboneElement
.... low 0..1SimpleQuantity
.... high 0..1SimpleQuantity
... derivedFrom 0..*Reference(QICoreObservation | QuestionnaireResponse)
... component S0..*BackboneElement
.... code S1..1CodeableConcept
.... value[x] S0..1Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
.... dataAbsentReason S0..1CodeableConcept
.... interpretation S0..*CodeableConcept
.... referenceRange 0..*

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*Measurements and simple assertions
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... observation-bodyPosition I0..1CodeableConceptThe body position during the observation
URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
... observation-delta I0..1CodeableConceptQualitative change or trend in the measurement
URL: http://hl7.org/fhir/StructureDefinition/observation-delta
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category S1..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)
... code SΣ1..1CodeableConceptType of observation (code / type)
Binding: LOINCCodes (example)
... subject SΣ1..1Reference(QICorePatient | QICoreDevice | QICoreLocation)Who and/or what the observation is about
... focus Σ0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter SΣ0..1Reference(QICoreEncounter)Healthcare event during which this observation is made
... effective[x] SΣ0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued SΣ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(QICorePractitioner | QICoreOrganization | QICorePatient | QICoreRelatedPerson)Who is responsible for the observation
... value[x] SΣI0..1Actual result
Binding: US Core Observation Value Codes (SNOMED-CT) (preferred)
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible)
... interpretation S0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
... note 0..*AnnotationComments about the observation
... bodySite S0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example)
... method S0..1CodeableConceptHow it was done
Binding: ObservationMethods (example)
... specimen S0..1Reference(QICoreSpecimen)Specimen used for this observation
... device 0..1Reference(QICoreDevice | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred)
.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom Σ0..*Reference(QICoreObservation | QuestionnaireResponse)Related measurements the observation is made from
... component SΣI0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example)
.... value[x] SΣ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible)
.... interpretation S0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
Observation.languagepreferredCommonLanguages
Max Binding: AllLanguages
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.codeexampleLOINCCodes
Observation.value[x]preferredUSCoreObservationValueCodes
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeexampleLOINCCodes
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2ObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-4ObservationIf 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-3ObservationIf 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-6ObservationA resource should have narrative for robust management
: text.div.exists()
dom-5ObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
obs-7ObservationIf 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.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()
obs-6ObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
ele-1Observation.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.referenceRangeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
obs-3Observation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
ele-1Observation.componentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())