AU Core Implementation Guide
1.0.0-ci-build - CI Build Australia flag

AU Core Implementation Guide, published by HL7 Australia. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7au/au-fhir-core/ and changes regularly. See the Directory of published versions

Resource Profile: AU Core Diagnostic Result Observation

Official URL: http://hl7.org.au/fhir/core/StructureDefinition/au-core-diagnosticresult Version: 1.0.0-ci-build
Standards status: Draft Maturity Level: 1 Computable Name: AUCoreDiagnosticResult

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License. HL7 Australia© 2022+; Licensed Under Creative Commons No Rights Reserved.

This profile sets minimum expectations for an Observation resource to record, search, and fetch diagnostic results associated with a patient. It is based on the AU Base Diagnostic Result profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets that SHALL be present in the Observation when conforming to this profile. It provides the floor for standards development for specific uses cases in an Australian context.

See Comparison with other national and international IGs for a comparison between AU Core profiles and profiles in other implementation guides.

Usage scenarios

The following are supported usage scenarios for this profile:

  • Query for diagnostic results for a patient
  • Query for category of diagnostic results (e.g. all cardiology results)
  • Record or update a diagnostic result for a patient

Profile specific implementation guidance

  • Observation.category provides an efficient way of supporting system interactions, e.g. restricting searches. Implementers need to understand that data categorisation is somewhat subjective. The categorisation applied by the source may not align with a receiver’s expectations.
  • The observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
    • providing a local code
    • providing a more specific code
  • The use of coding can vary significantly across systems, requesters need to understand that they may encounter codes they do not recognise and be prepared to handle those resources appropriately. Responders SHOULD populate Observation.code.text and/or Observation.code.coding.display so that the requester can at least display the observation even if the requester does not recognise the code supplied.
  • The Observation resource can represent a result using a single value in Observation.value, or can represent a set of results using either Observation.component.value or Observation.hasMember.
    • Although all are marked as Must Support, responders are not required to support all choices, but they SHALL support at least one of these elements
    • A requester SHALL support all elements (Observation.value, Observation.component.value, Observation.hasMember)
    • for further guidance, see the Observation Grouping section in FHIR Specification.
  • Observation.identifier may contain the same identifier as in the order or report connecting the resources that are related to a single request fulfilment workflow.
  • Source system identifiers that identify the business process (order ids and reporting identifiers) MAY be included as AU Local Order Identifier and AU Local Report Identifier to support workflow and deduplication of Observation resources.
    • See guidance on the construction of an identifier on the relevant Identifier profile page and the section on Business Identifiers in AU Base.

Usage:

Changes since version 1.0.0-ballot:

  • The data elements list has changed
  • One or more text definitions, invariants or bindings have changed
  • Formal Views of Profile Content

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

    This structure is derived from AUBaseDiagnosticResult

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* AUBaseDiagnosticResult A diagnostic result observation in an Australian healthcare context
    au-core-obs-02: If there is no component or hasMember element then at least value or data absent reason shall be present
    ... status SO 1..1 code preliminary | final | amended +
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... category SO 1..* CodeableConcept Diagnostic service section
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SO 1..1 CodeableConcept Diagnostic procedure
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... effective[x] SOC 1..1 dateTime, Period Clinically relevant time/time-period for observation
    au-core-obs-01: Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... performer SO 0..* Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Base Related Person) Who is responsible for the observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... value[x] SOC 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... dataAbsentReason SOC 0..1 CodeableConcept Why the result is missing
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... bodySite SOC 0..1 CodeableConcept Observed body part
    Binding: Body Site . (extensible)
    au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... hasMember SO 0..* Reference(AU Core Diagnostic Result Observation | AU Core Pathology Result Observation) Individual observations in a group, study, or panel
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... component SOC 0..* BackboneElement Component results
    au-core-obs-03: The component shall at least have a value or a data absent reason
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... code SO 1..1 CodeableConcept Type of component observation (code / type)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... value[x] SOC 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual component result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... dataAbsentReason SOC 0..1 CodeableConcept Why the component result is missing
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.bodySiteextensibleBodySite .
    https://healthterminologies.gov.au/fhir/ValueSet/body-site-1

    Constraints

    IdGradePath(s)DetailsRequirements
    au-core-obs-01errorObservation.effective[x]Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    : (($this is dateTime implies $this.toString().length() >= 10) and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not()) xor ($this.hasValue().not() and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists())
    au-core-obs-02errorObservationIf there is no component or hasMember element then at least value or data absent reason shall be present
    : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
    au-core-obs-03errorObservation.componentThe component shall at least have a value or a data absent reason
    : value.exists() or dataAbsentReason.exists()
    au-core-obs-04errorObservation.bodySiteIf a coded body site is provided, at least one code shall be from SNOMED CT
    : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* AUBaseDiagnosticResult A diagnostic result observation in an Australian healthcare context
    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
    inv-obs-0: A diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    au-core-obs-02: If there is no component or hasMember element then at least value or data absent reason shall be present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension Content/Rules for all slices
    .... bodySite 0..1 Reference(BodyStructure) Target anatomic location or structure
    URL: http://hl7.org/fhir/StructureDefinition/bodySite
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... category SO 1..* CodeableConcept Diagnostic service section
    Binding: DiagnosticServiceSectionCodes (preferred)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SOΣ 1..1 CodeableConcept Diagnostic procedure
    Binding: Evaluation Procedure . (example)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... subject SOΣ 1..1 Reference(AU Core Patient) Who and/or what the observation is about
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... effective[x] SOΣC 1..1 Clinically relevant time/time-period for observation
    au-core-obs-01: Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    ... performer SOΣ 0..* Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Base Related Person) Who is responsible for the observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... value[x] SOΣC 0..1 Actual result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... valueQuantity Quantity
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason SOC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... bodySite SOC 0..1 CodeableConcept Observed body part
    Binding: Body Site . (extensible)
    au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... hasMember SOΣC 0..* Reference(AU Core Diagnostic Result Observation | AU Core Pathology Result Observation) Individual observations in a group, study, or panel
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... component SOΣC 0..* BackboneElement Component results
    au-core-obs-03: The component shall at least have a value or a data absent reason
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SOΣ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... value[x] SOΣC 0..1 Actual component result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ..... valueQuantity Quantity
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SOC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester

    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.categorypreferredDiagnosticServiceSectionCodes
    http://hl7.org/fhir/ValueSet/diagnostic-service-sections
    from the FHIR Standard
    Observation.codeexampleEvaluationProcedure .
    https://healthterminologies.gov.au/fhir/ValueSet/evaluation-procedure-1
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.bodySiteextensibleBodySite .
    https://healthterminologies.gov.au/fhir/ValueSet/body-site-1
    Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    au-core-obs-01errorObservation.effective[x]Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    : (($this is dateTime implies $this.toString().length() >= 10) and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not()) xor ($this.hasValue().not() and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists())
    au-core-obs-02errorObservationIf there is no component or hasMember element then at least value or data absent reason shall be present
    : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
    au-core-obs-03errorObservation.componentThe component shall at least have a value or a data absent reason
    : value.exists() or dataAbsentReason.exists()
    au-core-obs-04errorObservation.bodySiteIf a coded body site is provided, at least one code shall be from SNOMED CT
    : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()
    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()
    inv-obs-0errorObservationA diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    : value.exists() or dataAbsentReason.exists() or hasMember.exists() or component.value.exists() or component.dataAbsentReason.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()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* AUBaseDiagnosticResult A diagnostic result observation in an Australian healthcare context
    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
    inv-obs-0: A diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    au-core-obs-02: If there is no component or hasMember element then at least value or data absent reason shall 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
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... bodySite 0..1 Reference(BodyStructure) Target anatomic location or structure
    URL: http://hl7.org/fhir/StructureDefinition/bodySite
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SOΣ 1..1 code preliminary | final | amended +
    Binding: ObservationStatus (required): Codes providing the status of an observation.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... category SO 1..* CodeableConcept Diagnostic service section
    Binding: DiagnosticServiceSectionCodes (preferred)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SOΣ 1..1 CodeableConcept Diagnostic procedure
    Binding: Evaluation Procedure . (example)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... subject SOΣ 1..1 Reference(AU Core Patient) Who and/or what the observation is about
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SOΣC 1..1 Clinically relevant time/time-period for observation
    au-core-obs-01: Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer SOΣ 0..* Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Base Related Person) Who is responsible for the observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... value[x] SOΣC 0..1 Actual result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... valueQuantity Quantity
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason SOC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite SOC 0..1 CodeableConcept Observed body part
    Binding: Body Site . (extensible)
    au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... method 0..1 CodeableConcept How it was done
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Specimen used for this observation
    ... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    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 SOΣC 0..* Reference(AU Core Diagnostic Result Observation | AU Core Pathology Result Observation) Individual observations in a group, study, or panel
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) Related measurements the observation is made from
    ... component SOΣC 0..* BackboneElement Component results
    au-core-obs-03: The component shall at least have a value or a data absent reason
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... 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 SOΣ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... value[x] SOΣC 0..1 Actual component result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ..... valueQuantity Quantity
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SOC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... 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.categorypreferredDiagnosticServiceSectionCodes
    http://hl7.org/fhir/ValueSet/diagnostic-service-sections
    from the FHIR Standard
    Observation.codeexampleEvaluationProcedure .
    https://healthterminologies.gov.au/fhir/ValueSet/evaluation-procedure-1
    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.bodySiteextensibleBodySite .
    https://healthterminologies.gov.au/fhir/ValueSet/body-site-1
    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.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    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
    au-core-obs-01errorObservation.effective[x]Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    : (($this is dateTime implies $this.toString().length() >= 10) and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not()) xor ($this.hasValue().not() and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists())
    au-core-obs-02errorObservationIf there is no component or hasMember element then at least value or data absent reason shall be present
    : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
    au-core-obs-03errorObservation.componentThe component shall at least have a value or a data absent reason
    : value.exists() or dataAbsentReason.exists()
    au-core-obs-04errorObservation.bodySiteIf a coded body site is provided, at least one code shall be from SNOMED CT
    : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()
    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()
    inv-obs-0errorObservationA diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    : value.exists() or dataAbsentReason.exists() or hasMember.exists() or component.value.exists() or component.dataAbsentReason.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()

    Differential View

    This structure is derived from AUBaseDiagnosticResult

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* AUBaseDiagnosticResult A diagnostic result observation in an Australian healthcare context
    au-core-obs-02: If there is no component or hasMember element then at least value or data absent reason shall be present
    ... status SO 1..1 code preliminary | final | amended +
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... category SO 1..* CodeableConcept Diagnostic service section
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SO 1..1 CodeableConcept Diagnostic procedure
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... effective[x] SOC 1..1 dateTime, Period Clinically relevant time/time-period for observation
    au-core-obs-01: Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... performer SO 0..* Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Base Related Person) Who is responsible for the observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... value[x] SOC 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... dataAbsentReason SOC 0..1 CodeableConcept Why the result is missing
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... bodySite SOC 0..1 CodeableConcept Observed body part
    Binding: Body Site . (extensible)
    au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... hasMember SO 0..* Reference(AU Core Diagnostic Result Observation | AU Core Pathology Result Observation) Individual observations in a group, study, or panel
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... component SOC 0..* BackboneElement Component results
    au-core-obs-03: The component shall at least have a value or a data absent reason
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... code SO 1..1 CodeableConcept Type of component observation (code / type)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... value[x] SOC 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual component result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... dataAbsentReason SOC 0..1 CodeableConcept Why the component result is missing
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.bodySiteextensibleBodySite .
    https://healthterminologies.gov.au/fhir/ValueSet/body-site-1

    Constraints

    IdGradePath(s)DetailsRequirements
    au-core-obs-01errorObservation.effective[x]Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    : (($this is dateTime implies $this.toString().length() >= 10) and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not()) xor ($this.hasValue().not() and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists())
    au-core-obs-02errorObservationIf there is no component or hasMember element then at least value or data absent reason shall be present
    : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
    au-core-obs-03errorObservation.componentThe component shall at least have a value or a data absent reason
    : value.exists() or dataAbsentReason.exists()
    au-core-obs-04errorObservation.bodySiteIf a coded body site is provided, at least one code shall be from SNOMED CT
    : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* AUBaseDiagnosticResult A diagnostic result observation in an Australian healthcare context
    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
    inv-obs-0: A diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    au-core-obs-02: If there is no component or hasMember element then at least value or data absent reason shall be present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension Content/Rules for all slices
    .... bodySite 0..1 Reference(BodyStructure) Target anatomic location or structure
    URL: http://hl7.org/fhir/StructureDefinition/bodySite
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... category SO 1..* CodeableConcept Diagnostic service section
    Binding: DiagnosticServiceSectionCodes (preferred)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SOΣ 1..1 CodeableConcept Diagnostic procedure
    Binding: Evaluation Procedure . (example)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... subject SOΣ 1..1 Reference(AU Core Patient) Who and/or what the observation is about
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... effective[x] SOΣC 1..1 Clinically relevant time/time-period for observation
    au-core-obs-01: Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    ... performer SOΣ 0..* Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Base Related Person) Who is responsible for the observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... value[x] SOΣC 0..1 Actual result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... valueQuantity Quantity
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason SOC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... bodySite SOC 0..1 CodeableConcept Observed body part
    Binding: Body Site . (extensible)
    au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... hasMember SOΣC 0..* Reference(AU Core Diagnostic Result Observation | AU Core Pathology Result Observation) Individual observations in a group, study, or panel
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... component SOΣC 0..* BackboneElement Component results
    au-core-obs-03: The component shall at least have a value or a data absent reason
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SOΣ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... value[x] SOΣC 0..1 Actual component result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ..... valueQuantity Quantity
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SOC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester

    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.categorypreferredDiagnosticServiceSectionCodes
    http://hl7.org/fhir/ValueSet/diagnostic-service-sections
    from the FHIR Standard
    Observation.codeexampleEvaluationProcedure .
    https://healthterminologies.gov.au/fhir/ValueSet/evaluation-procedure-1
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.bodySiteextensibleBodySite .
    https://healthterminologies.gov.au/fhir/ValueSet/body-site-1
    Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    au-core-obs-01errorObservation.effective[x]Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    : (($this is dateTime implies $this.toString().length() >= 10) and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not()) xor ($this.hasValue().not() and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists())
    au-core-obs-02errorObservationIf there is no component or hasMember element then at least value or data absent reason shall be present
    : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
    au-core-obs-03errorObservation.componentThe component shall at least have a value or a data absent reason
    : value.exists() or dataAbsentReason.exists()
    au-core-obs-04errorObservation.bodySiteIf a coded body site is provided, at least one code shall be from SNOMED CT
    : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()
    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()
    inv-obs-0errorObservationA diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    : value.exists() or dataAbsentReason.exists() or hasMember.exists() or component.value.exists() or component.dataAbsentReason.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()

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* AUBaseDiagnosticResult A diagnostic result observation in an Australian healthcare context
    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
    inv-obs-0: A diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    au-core-obs-02: If there is no component or hasMember element then at least value or data absent reason shall 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
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... bodySite 0..1 Reference(BodyStructure) Target anatomic location or structure
    URL: http://hl7.org/fhir/StructureDefinition/bodySite
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SOΣ 1..1 code preliminary | final | amended +
    Binding: ObservationStatus (required): Codes providing the status of an observation.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... category SO 1..* CodeableConcept Diagnostic service section
    Binding: DiagnosticServiceSectionCodes (preferred)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SOΣ 1..1 CodeableConcept Diagnostic procedure
    Binding: Evaluation Procedure . (example)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... subject SOΣ 1..1 Reference(AU Core Patient) Who and/or what the observation is about
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SOΣC 1..1 Clinically relevant time/time-period for observation
    au-core-obs-01: Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... effectiveDateTime dateTime
    .... effectivePeriod Period
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer SOΣ 0..* Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Base Related Person) Who is responsible for the observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... value[x] SOΣC 0..1 Actual result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... valueQuantity Quantity
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason SOC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite SOC 0..1 CodeableConcept Observed body part
    Binding: Body Site . (extensible)
    au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... method 0..1 CodeableConcept How it was done
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Specimen used for this observation
    ... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    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 SOΣC 0..* Reference(AU Core Diagnostic Result Observation | AU Core Pathology Result Observation) Individual observations in a group, study, or panel
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) Related measurements the observation is made from
    ... component SOΣC 0..* BackboneElement Component results
    au-core-obs-03: The component shall at least have a value or a data absent reason
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... 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 SOΣ 1..1 CodeableConcept Type of component observation (code / type)
    Binding: LOINCCodes (example): Codes identifying names of simple observations.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... value[x] SOΣC 0..1 Actual component result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ..... valueQuantity Quantity
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SOC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... 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.categorypreferredDiagnosticServiceSectionCodes
    http://hl7.org/fhir/ValueSet/diagnostic-service-sections
    from the FHIR Standard
    Observation.codeexampleEvaluationProcedure .
    https://healthterminologies.gov.au/fhir/ValueSet/evaluation-procedure-1
    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.bodySiteextensibleBodySite .
    https://healthterminologies.gov.au/fhir/ValueSet/body-site-1
    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.codeexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    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
    au-core-obs-01errorObservation.effective[x]Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    : (($this is dateTime implies $this.toString().length() >= 10) and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not()) xor ($this.hasValue().not() and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists())
    au-core-obs-02errorObservationIf there is no component or hasMember element then at least value or data absent reason shall be present
    : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
    au-core-obs-03errorObservation.componentThe component shall at least have a value or a data absent reason
    : value.exists() or dataAbsentReason.exists()
    au-core-obs-04errorObservation.bodySiteIf a coded body site is provided, at least one code shall be from SNOMED CT
    : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()
    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()
    inv-obs-0errorObservationA diagnostic result shall at least have value or data absent reason or a child observation with a value or data absent reason
    : value.exists() or dataAbsentReason.exists() or hasMember.exists() or component.value.exists() or component.dataAbsentReason.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()

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Below is an overview of the mandatory and optional search parameters and combined search parameters. See the AU Core CapabilityStatements for a complete list of supported RESTful interactions for this IG.

    FHIR search operations are described here and the syntax used to describe AU Core interactions is defined here.

    Any search parameter defined in FHIR may be ‘allowed’ by the system unless explicitly marked as “SHALL NOT”. A few items are marked as MAY in this implementation guide to highlight their potential relevance.

    Parameter(s) Conformance Type(s) Requirements (when used alone or in combination)
    patient+category SHALL reference+token
    patient+category+date SHALL reference+token+date
    patient+code SHALL reference+token
    patient+category+status SHOULD reference+token+token
    patient+code+date SHOULD reference+token+date
    patient.identifier SHOULD reference.token The requester SHALL provide both the system and code values. The responder SHALL support both.

    The requester SHOULD support search using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile. The responder SHOULD support search using the using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile.
    patient MAY reference The requester SHALL provide at least an id value and MAY provide both the Type and id values. The responder SHALL support both.
    category MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHALL support search using the category code defined in this profile. The responder SHALL support search using the category code defined in this profile.
    code MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHALL support search using the LOINC codes defined in this profile. The responder SHALL support search using the LOINC codes defined in this profile.

    The requester SHALL support multipleOr. The responder SHALL support multipleOr.
    date MAY date A requester SHALL provide a value precise to the second + time offset. A responder SHALL support a value precise to the second + time offset.

    The requester SHALL support these search comparators gt, lt, ge, le. The responder SHALL support these search comparators gt, lt, ge, le.

    The requester SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le. The responder SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le.
    status MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHALL support multipleOr.The responder SHALL support multipleOr.

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching using the combination of the patient and category search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

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

      Example:

      1. GET [base]/Observation?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|survey

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = survey (how to search by reference and how to search by token)

    2. SHALL support searching using the combination of the patient and code search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHOULD support multipleOr search on code (e.g.code={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=5678&code=http://snomed.info/sct|89240007,http://loinc.org|14683-7,http://loinc.org|85354-9

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). The Observation code parameter searches Observation.code only. (how to search by reference and how to search by token)

    3. SHALL support searching using the combination of the patient and category and date search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support these date comparators: gt,lt,ge,le
      • SHOULD support multipleAnd search on date (e.g.date=[date]&date=[date]]&...), and if multipleAnd is supported, SHALL support the search comparators gt,lt,ge,le

      GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|survey&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and category (how to search by reference and how to search by token and how to search by date)

    Optional Search Parameters:

    The following search parameters and search parameter combinations SHOULD be supported:

    1. SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/Observation?patient.identifier=[system|][code]

      Example:

      1. GET [base]/Observation?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952
      2. GET [base]/Observation?patient.identifier=http://ns.electronichealth.net.au/id/hi/ihi/1.0|8003608833357361

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and category and status search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support multipleOr search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|survey&status=final

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and status (how to search by reference and how to search by token)

    3. SHOULD support searching using the combination of the patient and code and date search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code]
      • SHOULD support multipleOr search on code (e.g.code={system|}[code],{system|}[code],...)
      • SHALL support these date comparators: gt,lt,ge,le
      • SHOULD support multipleAnd search on date (e.g.date=[date]&date=[date]]&...), and if multipleAnd is supported, SHALL support the search comparators gt,lt,ge,le

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=5678&code=http://snomed.info/sct|89240007,http://loinc.org|14683-7,http://loinc.org|85354-9&date=ge2020-01-01T00:00:00Z
      2. GET [base]/Observation?patient.identifier=http://example.org/fhir/mrn|12345&code=http://snomed.info/sct|89240007,http://loinc.org|14683-7,http://loinc.org|85354-9&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and observation code(s). SHOULD support search by multiple codes. (how to search by reference and how to search by token and how to search by date)