Interweave Implementation Guide
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Interweave Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the STU3 profiles here.

Resource Profile: InterweaveObservationACVPU

Official URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Observation-ACVPU Version: 0.0.1
Draft as of 2024-07-15 Computable Name: InterweaveObservationACVPU

Interweave Observation ACVPU resource profile - DRAFT.

Status: DRAFT: For Review

Introduction

This profile sets out the expectations for the interweave ACVPU observation resource. The base for this profile is the UK Core Observation ACVPU.

We have enforced the use of SNOMED codes where possible and have removed the component field. This is to ensure that the valueCodeableConcept field is used to provide the result.

Mandatory fields

The following mandatory fields are defined:

  1. status – Fixed value of ‘final’. Only finalised observations should be shared.

  2. category – Fixed value of ‘vital-signs’.

  3. code – Fixed value of SCT: 1104441000000107 (ACVPU (Alert Confusion Voice Pain Unresponsive) scale score).

  4. subject – Reference to the patient who is the subject of this measurement.

  5. effective – An important field to provide details of the time/time period during which the observation was taken.

Must Support fields

In addition the following fields are "Must Support" - ie they must be populated if relevant and known.

  1. identifier - A Local Id should be provided, such that could be quoted if manually getting in touch to find out more.

  2. encounter – his will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests). For some observations it may be important to know the link between an observation and a particular encounter.

  3. performer – We limit this field to reference practitioner / practitionerRole/ CareTeam resources only. The organization responsible for the observation can be obtained via the provenance tag.

  4. note – Comments in addition to the result are often recorded for observations, it is therefore important to provide this field when available to give the consumer the full result information.

  5. valueCodeableConcept – The actual result recorded. This is a required binding to the Care Connect ACVPU code system which Include codes from SNOMED_CT where constraint Equal (248234008 (Mentally alert) OR 300202002 (Responds to voice) OR 450847001 (Responds to pain) OR 422768004 (Unresponsive) OR 130987000 (Acute confusion))

  6. dataAbsentReason - The reason why the result is missing, this is valuable if a value has not been obtained for some reason e.g. a patient refused. This field can only be provided when there is no value present.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Points of note include:

  • method – Option to provide the mechanism used to perform the observation

  • device – Opportunity to provide a link to a device resource from which was used to obtain the observation.

Discouraged or Removed fields

  • basedOn – This field is discouraged as it does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.

  • partOf – This field is discouraged as it does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.

  • derivedFrom – This field is discouraged as it does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.

  • issued – This field has been removed as this information can be taken from the mandatory meta.lastUpdated field, and to also avoid any confusion with the other date fields.

  • Component – Removed to aid the data consumer, we ask that the result is provided in the valueCodeableConcept field and not in the component field.

  • specimen – Removed.
  • bodysite - Removed.
  • Interpretation - Removed.
  • ReferenceRange - Removed.

Usage:

  • This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

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

This structure is derived from UKCoreObservationACVPU

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..* UKCoreObservationACVPU Measurements and simple assertions
... id S 0..1 id Logical id of this artifact
... meta
.... id 0..0
.... versionId S 0..1 id Version specific identifier
.... lastUpdated S 0..1 instant MANDATORY except in Contained Resources. When the resource version last changed.
.... profile S 0..* canonical(StructureDefinition) Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
.... security 0..* Coding DISCOURAGED - may not be honoured by Data Consumers
.... Slices for tag 0..* Coding Tags applied to this resource
Slice: Unordered, Open by value:system
..... tag:Source S 0..1 Coding MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
...... id 0..0
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
...... version 0..0
...... code S 1..1 code The Data Provider Id of the system supplying the data
...... display S 1..1 string Name of the system supplying the data
..... tag:Provenance S 0..1 Coding MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
...... id 0..0
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
...... version 0..0
...... code S 1..1 code The ODS Code of the organisation responsible for the data
...... display S 1..1 string Name of the organisation supplying the data
... implicitRules 0..1 uri DISCOURAGED - may not be honoured by Data Consumers
... language 0..1 code English is assumed (not currently a multi-lingual implementation)
... text 0..1 Narrative DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... Slices for extension Content/Rules for all slices
.... extension:triggeredByR5 0..0
... identifier S 0..* Identifier Business Identifier for observation
.... assigner 0..1 Reference(InterweaveOrganization) Organization that issued id (may be just text)
... basedOn 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... partOf 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... category
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
..... version 0..0
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
..... display 1..1 string Representation defined by the system
Fixed Value: Vital Signs
... code
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://snomed.info/sct
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
Fixed Value: Alert Confusion Voice Pain Unresponsive scale score
... subject 1..1 Reference(InterweavePatient) Who and / or what the observation is about.
.... id 0..0
.... reference 1..1 string Reference to a resource (could be Contained)
.... identifier 0..1 Identifier If relevant could include an id
.... display 1..1 string Description of the referenced resource
... focus 0..0
... encounter S 0..1 Reference(InterweaveEncounter) Healthcare event during which this observation is made
... effective[x] 1..1 This is the time/time period during which the observation was taken.
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveInstant instant
... issued 0..0
... performer 0..* Reference(Practitioner | PractitionerRole | CareTeam) Who is responsible for the observation.
.... id 0..0
.... reference 1..1 string Reference to a resource (could be Contained)
.... identifier 0..1 Identifier If relevant could include an id
.... display 1..1 string Description of the referenced resource
... value[x] 0..1 CodeableConcept The actual observed result.
Binding: UK Core ACVPU (required)
.... coding
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://snomed.info/sct
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
... dataAbsentReason S 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (required)
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
... interpretation 0..0
... note S 0..1 Annotation Comments about the observation
... bodySite 0..0
... method
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
... specimen 0..0
... device 0..1 Reference(Device) (Measurement) Device
... referenceRange 0..0
... hasMember 0..0
... derivedFrom 0..* Reference(InterweaveObservation | InterweaveQuestionnaireResponse) Related measurements the observation is made from

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.value[x]requiredUKCoreACVPU
https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU
from this IG
Observation.dataAbsentReasonrequiredDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* UKCoreObservationACVPU Measurements and simple assertions
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
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... versionId SΣ 0..1 id Version specific identifier
.... lastUpdated SΣ 0..1 instant MANDATORY except in Contained Resources. When the resource version last changed.
.... profile SΣ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
.... security Σ 0..* Coding DISCOURAGED - may not be honoured by Data Consumers
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... Slices for tag Σ 0..* Coding Tags applied to this resource
Slice: Unordered, Open by value:system
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


..... tag:Source SΣ 0..1 Coding MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
...... code SΣ 1..1 code The Data Provider Id of the system supplying the data
...... display SΣ 1..1 string Name of the system supplying the data
..... tag:Provenance SΣ 0..1 Coding MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
...... code SΣ 1..1 code The ODS Code of the organisation responsible for the data
...... display SΣ 1..1 string Name of the organisation supplying the data
... implicitRules ?!Σ 0..1 uri DISCOURAGED - may not be honoured by Data Consumers
... text 0..1 Narrative DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... Slices for extension Content/Rules for all slices
.... bodyStructureR5 0..1 Reference(BodyStructure) Observed body structure. This is a R5 backport.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Business Identifier for observation
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... assigner Σ 0..1 Reference(InterweaveOrganization) Organization that issued id (may be just text)
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... status ?!SΣ 1..1 code The status of the result value.
Binding: ObservationStatus (required): Codes providing the status of an observation.


Fixed Value: final
... category S 1..1 CodeableConcept A code that classifies the general type of observation being made.
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


... code SΣ 1..1 CodeableConcept The type of observation (code / type).
Binding: UK Core Observation Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation

... subject SΣ 1..1 Reference(InterweavePatient) Who and / or what the observation is about.
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... encounter SΣ 0..1 Reference(InterweaveEncounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 This is the time/time period during which the observation was taken.
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveInstant instant
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | CareTeam) Who is responsible for the observation.
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... value[x] SΣC 0..1 CodeableConcept The actual observed result.
Binding: UK Core ACVPU (required)
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (required)
... note S 0..1 Annotation Comments about the observation
... device 0..1 Reference(Device) (Measurement) Device
... derivedFrom Σ 0..* Reference(InterweaveObservation | InterweaveQuestionnaireResponse) Related measurements the observation is made from

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Observation.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:SourceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:ProvenanceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]requiredhttp://hl7.org/fhir/ValueSet/observation-triggeredbytype
http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Observation.statusrequiredFixed Value: final
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.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG
Observation.value[x]requiredUKCoreACVPU
https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU
from this IG
Observation.dataAbsentReasonrequiredDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG

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()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* UKCoreObservationACVPU Measurements and simple assertions
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
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId SΣ 0..1 id Version specific identifier
.... lastUpdated SΣ 0..1 instant MANDATORY except in Contained Resources. When the resource version last changed.
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile SΣ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
.... security Σ 0..* Coding DISCOURAGED - may not be honoured by Data Consumers
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... Slices for tag Σ 0..* Coding Tags applied to this resource
Slice: Unordered, Open by value:system
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


..... tag:Source SΣ 0..1 Coding MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... 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: https://fhir.interweavedigital.nhs.uk/Source
...... code SΣ 1..1 code The Data Provider Id of the system supplying the data
...... display SΣ 1..1 string Name of the system supplying the data
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... tag:Provenance SΣ 0..1 Coding MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... 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: https://fhir.interweavedigital.nhs.uk/Provenance
...... code SΣ 1..1 code The ODS Code of the organisation responsible for the data
...... display SΣ 1..1 string Name of the organisation supplying the data
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
... implicitRules ?!Σ 0..1 uri DISCOURAGED - may not be honoured by Data Consumers
... text 0..1 Narrative DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... bodyStructureR5 0..1 Reference(BodyStructure) Observed body structure. This is a R5 backport.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Business Identifier for observation
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ 0..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(InterweaveOrganization) Organization that issued id (may be just text)
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... status ?!SΣ 1..1 code The status of the result value.
Binding: ObservationStatus (required): Codes providing the status of an observation.


Fixed Value: final
... category S 1..1 CodeableConcept A code that classifies the general type of observation being made.
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... 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://terminology.hl7.org/CodeSystem/observation-category
..... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
..... display Σ 1..1 string Representation defined by the system
Fixed Value: Vital Signs
..... 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 SΣ 1..1 CodeableConcept The type of observation (code / type).
Binding: UK Core Observation Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation

.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... 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://snomed.info/sct
..... 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: 1104441000000107
..... display Σ 1..1 string Representation defined by the system
Fixed Value: Alert Confusion Voice Pain Unresponsive scale score
..... 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(InterweavePatient) Who and / or what the observation is about.
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... encounter SΣ 0..1 Reference(InterweaveEncounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 This is the time/time period during which the observation was taken.
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveInstant instant
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | CareTeam) Who is responsible for the observation.
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... value[x] SΣC 0..1 CodeableConcept The actual observed result.
Binding: UK Core ACVPU (required)
.... 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 Σ 0..* 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://snomed.info/sct
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..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
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (required)
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..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
... note S 0..1 Annotation Comments about the observation
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (preferred): Methods for simple observations.

.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..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
... device 0..1 Reference(Device) (Measurement) Device
... derivedFrom Σ 0..* Reference(InterweaveObservation | InterweaveQuestionnaireResponse) Related measurements the observation is made from

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Observation.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:SourceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:ProvenanceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]requiredhttp://hl7.org/fhir/ValueSet/observation-triggeredbytype
http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Observation.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Observation.statusrequiredFixed Value: final
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.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG
Observation.subject.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Observation.performer.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Observation.value[x]requiredUKCoreACVPU
https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU
from this IG
Observation.dataAbsentReasonrequiredDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.methodpreferredObservationMethods
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.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG
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-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 UKCoreObservationACVPU

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..* UKCoreObservationACVPU Measurements and simple assertions
... id S 0..1 id Logical id of this artifact
... meta
.... id 0..0
.... versionId S 0..1 id Version specific identifier
.... lastUpdated S 0..1 instant MANDATORY except in Contained Resources. When the resource version last changed.
.... profile S 0..* canonical(StructureDefinition) Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
.... security 0..* Coding DISCOURAGED - may not be honoured by Data Consumers
.... Slices for tag 0..* Coding Tags applied to this resource
Slice: Unordered, Open by value:system
..... tag:Source S 0..1 Coding MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
...... id 0..0
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
...... version 0..0
...... code S 1..1 code The Data Provider Id of the system supplying the data
...... display S 1..1 string Name of the system supplying the data
..... tag:Provenance S 0..1 Coding MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
...... id 0..0
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
...... version 0..0
...... code S 1..1 code The ODS Code of the organisation responsible for the data
...... display S 1..1 string Name of the organisation supplying the data
... implicitRules 0..1 uri DISCOURAGED - may not be honoured by Data Consumers
... language 0..1 code English is assumed (not currently a multi-lingual implementation)
... text 0..1 Narrative DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... Slices for extension Content/Rules for all slices
.... extension:triggeredByR5 0..0
... identifier S 0..* Identifier Business Identifier for observation
.... assigner 0..1 Reference(InterweaveOrganization) Organization that issued id (may be just text)
... basedOn 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... partOf 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... category
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
..... version 0..0
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
..... display 1..1 string Representation defined by the system
Fixed Value: Vital Signs
... code
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://snomed.info/sct
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
Fixed Value: Alert Confusion Voice Pain Unresponsive scale score
... subject 1..1 Reference(InterweavePatient) Who and / or what the observation is about.
.... id 0..0
.... reference 1..1 string Reference to a resource (could be Contained)
.... identifier 0..1 Identifier If relevant could include an id
.... display 1..1 string Description of the referenced resource
... focus 0..0
... encounter S 0..1 Reference(InterweaveEncounter) Healthcare event during which this observation is made
... effective[x] 1..1 This is the time/time period during which the observation was taken.
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveInstant instant
... issued 0..0
... performer 0..* Reference(Practitioner | PractitionerRole | CareTeam) Who is responsible for the observation.
.... id 0..0
.... reference 1..1 string Reference to a resource (could be Contained)
.... identifier 0..1 Identifier If relevant could include an id
.... display 1..1 string Description of the referenced resource
... value[x] 0..1 CodeableConcept The actual observed result.
Binding: UK Core ACVPU (required)
.... coding
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://snomed.info/sct
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
... dataAbsentReason S 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (required)
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
... interpretation 0..0
... note S 0..1 Annotation Comments about the observation
... bodySite 0..0
... method
.... id 0..0
.... coding
..... id 0..0
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
... specimen 0..0
... device 0..1 Reference(Device) (Measurement) Device
... referenceRange 0..0
... hasMember 0..0
... derivedFrom 0..* Reference(InterweaveObservation | InterweaveQuestionnaireResponse) Related measurements the observation is made from

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.value[x]requiredUKCoreACVPU
https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU
from this IG
Observation.dataAbsentReasonrequiredDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* UKCoreObservationACVPU Measurements and simple assertions
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
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... versionId SΣ 0..1 id Version specific identifier
.... lastUpdated SΣ 0..1 instant MANDATORY except in Contained Resources. When the resource version last changed.
.... profile SΣ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
.... security Σ 0..* Coding DISCOURAGED - may not be honoured by Data Consumers
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... Slices for tag Σ 0..* Coding Tags applied to this resource
Slice: Unordered, Open by value:system
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


..... tag:Source SΣ 0..1 Coding MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
...... code SΣ 1..1 code The Data Provider Id of the system supplying the data
...... display SΣ 1..1 string Name of the system supplying the data
..... tag:Provenance SΣ 0..1 Coding MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
...... code SΣ 1..1 code The ODS Code of the organisation responsible for the data
...... display SΣ 1..1 string Name of the organisation supplying the data
... implicitRules ?!Σ 0..1 uri DISCOURAGED - may not be honoured by Data Consumers
... text 0..1 Narrative DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... Slices for extension Content/Rules for all slices
.... bodyStructureR5 0..1 Reference(BodyStructure) Observed body structure. This is a R5 backport.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Business Identifier for observation
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... assigner Σ 0..1 Reference(InterweaveOrganization) Organization that issued id (may be just text)
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... status ?!SΣ 1..1 code The status of the result value.
Binding: ObservationStatus (required): Codes providing the status of an observation.


Fixed Value: final
... category S 1..1 CodeableConcept A code that classifies the general type of observation being made.
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


... code SΣ 1..1 CodeableConcept The type of observation (code / type).
Binding: UK Core Observation Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation

... subject SΣ 1..1 Reference(InterweavePatient) Who and / or what the observation is about.
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... encounter SΣ 0..1 Reference(InterweaveEncounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 This is the time/time period during which the observation was taken.
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveInstant instant
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | CareTeam) Who is responsible for the observation.
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... value[x] SΣC 0..1 CodeableConcept The actual observed result.
Binding: UK Core ACVPU (required)
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (required)
... note S 0..1 Annotation Comments about the observation
... device 0..1 Reference(Device) (Measurement) Device
... derivedFrom Σ 0..* Reference(InterweaveObservation | InterweaveQuestionnaireResponse) Related measurements the observation is made from

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Observation.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:SourceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:ProvenanceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]requiredhttp://hl7.org/fhir/ValueSet/observation-triggeredbytype
http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Observation.statusrequiredFixed Value: final
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.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG
Observation.value[x]requiredUKCoreACVPU
https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU
from this IG
Observation.dataAbsentReasonrequiredDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG

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()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* UKCoreObservationACVPU Measurements and simple assertions
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
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId SΣ 0..1 id Version specific identifier
.... lastUpdated SΣ 0..1 instant MANDATORY except in Contained Resources. When the resource version last changed.
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile SΣ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
.... security Σ 0..* Coding DISCOURAGED - may not be honoured by Data Consumers
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... Slices for tag Σ 0..* Coding Tags applied to this resource
Slice: Unordered, Open by value:system
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


..... tag:Source SΣ 0..1 Coding MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... 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: https://fhir.interweavedigital.nhs.uk/Source
...... code SΣ 1..1 code The Data Provider Id of the system supplying the data
...... display SΣ 1..1 string Name of the system supplying the data
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... tag:Provenance SΣ 0..1 Coding MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


...... 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: https://fhir.interweavedigital.nhs.uk/Provenance
...... code SΣ 1..1 code The ODS Code of the organisation responsible for the data
...... display SΣ 1..1 string Name of the organisation supplying the data
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
... implicitRules ?!Σ 0..1 uri DISCOURAGED - may not be honoured by Data Consumers
... text 0..1 Narrative DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... bodyStructureR5 0..1 Reference(BodyStructure) Observed body structure. This is a R5 backport.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Business Identifier for observation
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ 0..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(InterweaveOrganization) Organization that issued id (may be just text)
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
... status ?!SΣ 1..1 code The status of the result value.
Binding: ObservationStatus (required): Codes providing the status of an observation.


Fixed Value: final
... category S 1..1 CodeableConcept A code that classifies the general type of observation being made.
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... 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://terminology.hl7.org/CodeSystem/observation-category
..... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
..... display Σ 1..1 string Representation defined by the system
Fixed Value: Vital Signs
..... 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 SΣ 1..1 CodeableConcept The type of observation (code / type).
Binding: UK Core Observation Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation

.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... 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://snomed.info/sct
..... 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: 1104441000000107
..... display Σ 1..1 string Representation defined by the system
Fixed Value: Alert Confusion Voice Pain Unresponsive scale score
..... 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(InterweavePatient) Who and / or what the observation is about.
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... encounter SΣ 0..1 Reference(InterweaveEncounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 This is the time/time period during which the observation was taken.
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveInstant instant
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | CareTeam) Who is responsible for the observation.
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string Reference to a resource (could be Contained)
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier If relevant could include an id
.... display Σ 1..1 string Description of the referenced resource
... value[x] SΣC 0..1 CodeableConcept The actual observed result.
Binding: UK Core ACVPU (required)
.... 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 Σ 0..* 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://snomed.info/sct
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..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
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (required)
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..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
... note S 0..1 Annotation Comments about the observation
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (preferred): Methods for simple observations.

.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..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
... device 0..1 Reference(Device) (Measurement) Device
... derivedFrom Σ 0..* Reference(InterweaveObservation | InterweaveQuestionnaireResponse) Related measurements the observation is made from

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Observation.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:SourceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.meta.tag:ProvenanceexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]requiredhttp://hl7.org/fhir/ValueSet/observation-triggeredbytype
http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Observation.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Observation.statusrequiredFixed Value: final
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.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG
Observation.subject.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Observation.performer.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Observation.value[x]requiredUKCoreACVPU
https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU
from this IG
Observation.dataAbsentReasonrequiredDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.methodpreferredObservationMethods
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.codepreferredUKCoreObservationType
https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
from this IG
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-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:

Differences between Interweave STU3 and R4 profiles

Element name Change details
extension:bodyStructureR5
  • Added Element
category
  • Change of codeSystem from http://hl7.org/fhir/observation-category to http://terminology.hl7.org/CodeSystem/observation-category
category.coding.system
  • Change of fixed value from http://hl7.org/fhir/observation-category to http://terminology.hl7.org/CodeSystem/observation-category
code
  • Changed valueSet from https://fhir.hl7.org.uk/STU3/ValueSet/CareConnect-ObservationType-1 to https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType
encounter
  • Renamed from context to encounter
effective[x]
  • Add Type instant
performer
  • Type Reference: Added Target Types PractitionerRole, CareTeam
valueCodeableConcept
  • Changed valueSet from https://fhir.hl7.org.uk/STU3/ValueSet/CareConnect-ACVPU-1 to https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU
dataAbsentReason
  • Changed valueSet from http://hl7.org/fhir/ValueSet/observation-valueabsentreason to http://hl7.org/fhir/ValueSet/data-absent-reason
  • Change of codeSystem from http://hl7.org/fhir/data-absent-reason to http://terminology.hl7.org/CodeSystem/data-absent-reason
interpretation
  • Deleted
note
  • Renamed from comment to note
  • Type changed from string to Annotation
referenceRange
  • Deleted
bodySite
  • Deleted
derivedFrom
  • Renamed from related to derivedFrom
  • Type changed from BackboneElement to Reference
  • Type Reference: Added Target Type QuestionnaireResponse