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.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from UKCoreObservationACVPU

Name	Flags	Card.	Type	Description & Constraints
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
effectiveInstant			instant
issued		0..0
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
referenceRange		0..0
hasMember		0..0
derivedFrom		0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	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.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.value[x]	required	UKCoreACVPU https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints
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
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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
effectiveInstant			instant
performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation.
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
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	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.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Observation.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]	required	http://hl7.org/fhir/ValueSet/observation-triggeredbytype http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.value[x]	required	UKCoreACVPU https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If 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()

Name	Flags	Card.	Type	Description & Constraints
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
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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
effectiveInstant			instant
performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation.
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 | DeviceMetric)	(Measurement) Device
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	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.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Observation.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]	required	http://hl7.org/fhir/ValueSet/observation-triggeredbytype http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Observation.value[x]	required	UKCoreACVPU https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.method	preferred	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If 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

Name	Flags	Card.	Type	Description & Constraints
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
effectiveInstant			instant
issued		0..0
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
referenceRange		0..0
hasMember		0..0
derivedFrom		0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	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.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.value[x]	required	UKCoreACVPU https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
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
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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
effectiveInstant			instant
performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation.
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
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	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.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Observation.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]	required	http://hl7.org/fhir/ValueSet/observation-triggeredbytype http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.value[x]	required	UKCoreACVPU https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If 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

Name	Flags	Card.	Type	Description & Constraints
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
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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
effectiveInstant			instant
performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation.
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 | DeviceMetric)	(Measurement) Device
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	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.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Observation.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.extension:triggeredByR5.extension:type.value[x]	required	http://hl7.org/fhir/ValueSet/observation-triggeredbytype http://hl7.org/fhir/ValueSet/observation-triggeredbytype
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Observation.value[x]	required	UKCoreACVPU https://fhir.hl7.org.uk/ValueSet/UKCore-ACVPU from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.method	preferred	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If 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()

This structure is derived from UKCoreObservationACVPU

Summary

Mandatory: 2 elements(21 nested mandatory elements)
Must-Support: 14 elements
Fixed: 8 elements
Prohibited: 27 elements

Structures

This structure refers to these other structures:

• InterweaveOrganization (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Organization)
• InterweavePatient (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Patient)
• InterweaveEncounter (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Encounter)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Observation.meta.tag