Status: DRAFT: For Review

Introduction

This profile sets out the expectations for the interweave vital signs observation resource. The base for this profile is the CareConnect-VitalSigns-Observation-1 and we have made little adjustment to this base profile by enforcing the use of SNOMED codes where possible.

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 – This is the type of observation. UK Core has mendated a LOINC "magic code" describing the type of observation and set of SNOMED CT codes defined in UK Core Observation Vital Signs Type with preferred binding. Should you wish to use a local code set to populate SNOMED code, as detailed in the conformance section of this implementation guide, you must contact us for explicit approval to do so.

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 – This 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. valueQuantity – Vital Sign Value recorded with UCUM. We cannot make the field mandatory, as there maybe occasions where a result is missing (see dataAbsentReason below) or the result may be housed within the component field instead.

5. 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.

6. interpretation - This is also known as the ‘abnormal flag’ and is regularly recorded alongside the actual result. It is used to signal the meaning of the result.

7. 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.

8. bodySite - A long list of SNOMED codes which represent the observed parts of the body.

9. referenceRange - To aid the interpretation of a result, it is important to include the reference range.

10. component – The component field is used to house multiple code/value pairs which make up a single result, such as systolic and diastolic measurements which in combination represent blood pressure. If the display order of values held in the component field has importance, then they should be provided in the order in which they should be displayed.

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

• specimen – Opportunity to provide a link to a specimen resource from which the observation was obtained.

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

• derivedFrom – To reduce complexity, we limit the related field’s usage to only allow links to observation / Questionnaire Response resources, from which the primary observation’s value was derived. E.g. An observation may have a value which is a score, and that score may have been derived from several other observations.

• bodyStructureR5 (extension) - Indicates the body structure on the subject's body where the observation was made (i.e. the target site). This is a R5 backport.

• bodyPosition (extension) - The position of the body when the observation was done, e.g. standing, sitting. To be used only when the body position in not precoordinated in the observation code.

• recordingSetting (extension) - This extension allows the recording of the care setting in which an observation was performed in a clinical or non clinical setting.

• valuePrecision (extension) – We use the FHIR precision extension (Extension: precision - FHIR v4.3.0 (hl7.org)) to allow the decimal precision of a result value to be provided where it is of importance. This extension will also be available within the component field.

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.

• 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.

• focus - Removed.

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

This structure is derived from UKCoreObservationVitalSigns

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	UKCoreObservationVitalSigns	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
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
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		1..1	CodeableConcept	A category of `vital-signs` SHALL be present. Binding: ObservationCategoryCodes (required): Codes for high level observation categories.
id		0..0
extension		0..0
coding
id		0..0
extension		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 Fixed Value: Vital Signs
code		1..1	CodeableConcept	The type of vital signs observation (code / type). Binding: UK Core Observation Vital Signs Type (preferred)
id		0..0
Slices for coding				Content/Rules for all slices
coding:loinc		1..1	Coding	A LOINC "magic code" describing the type of observation SHALL be present.
version		0..0
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:snomedCT		1..*	Coding	A SNOMED CT concept describing the type of observation SHALL be present.
version		0..0
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
subject		1..1	Reference(InterweavePatient)	Who or what the observation relates to SHALL be present.
id		0..0
extension		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.
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	Quantity	The actual observed result.
dataAbsentReason	S	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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
note	S	0..1	Annotation	Comments about the observation
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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
method
id		0..0
extension		0..0
coding
id		0..0
extension		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
device		0..1	Reference(Device)	(Measurement) Device
referenceRange	S	0..*	BackboneElement	Provides guide for interpretation
id		0..0
extension		0..0
hasMember		0..0
derivedFrom		0..*	Reference(InterweaveObservation | InterweaveQuestionnaireResponse)	Related measurements the observation is made from
component
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
valuePrecision		0..1	integer	Explicit precision (number of significant decimal places) URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
code	S	1..1	CodeableConcept	Type of component observation (code / type)
id		0..0
extension		0..0
coding
id		0..0
extension		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
value[x]	S	0..1	Quantity	Actual component result
dataAbsentReason	S	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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
referenceRange	S	0..*		Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.category	required	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.component.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	UKCoreObservationVitalSigns	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 ukcore-obs-vs-001: `code.coding` SHALL include a LOINC "magic code"
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
bodyPosition		0..1	(Complex)	The patients body position when the vital signs observation was recorded. URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/observation-bodyPosition"
value[x]		1..1	CodeableConcept	Value of extension Binding: UK Core Body Position (preferred)
recordingSetting		0..*	CodeableConcept	Records whether the vital signs observation was performed in a clinical or non clinical setting. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-RecordingSetting
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
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	A status of `final` SHALL be present. Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
category	S	1..1	CodeableConcept	A category of `vital-signs` SHALL be present. Binding: ObservationCategoryCodes (required): Codes for high level observation categories.
extension		0..0
code	SΣ	1..1	CodeableConcept	The type of vital signs observation (code / type). Binding: UK Core Observation Vital Signs Type (preferred)
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:loinc	Σ	1..1	Coding	A LOINC "magic code" describing the type of observation SHALL be present. Binding: VitalSigns (extensible)
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	1..*	Coding	A SNOMED CT concept describing the type of observation SHALL be present. Binding: UK Core Observation Vital Signs Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
subject	SΣ	1..1	Reference(InterweavePatient)	Who or what the observation relates to SHALL be present.
extension		0..0
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	Quantity	The actual observed result.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (required)
extension		0..0
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
note	S	0..1	Annotation	Comments about the observation
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (required)
extension		0..0
device		0..1	Reference(Device)	(Measurement) Device
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
derivedFrom	Σ	0..*	Reference(InterweaveObservation | InterweaveQuestionnaireResponse)	Related measurements the observation is made from
component	SΣ	0..*	BackboneElement	Component / sub results.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
valuePrecision		0..1	integer	Explicit precision (number of significant decimal places) URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component 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..0
value[x]	SΣ	0..1	Quantity	Actual component result
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (required)
extension		0..0
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
referenceRange	S	0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
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.extension:bodyPosition.value[x]	preferred	UKCoreBodyPosition https://fhir.hl7.org.uk/ValueSet/UKCore-BodyPosition from this IG
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	required	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.code.coding:loinc	extensible	VitalSigns http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.code.coding:snomedCT	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.component.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.component.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	required	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-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.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()
ukcore-obs-vs-001	error	Observation	`code.coding` SHALL include a LOINC "magic code" : code.coding.where(system='http://loinc.org').exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	UKCoreObservationVitalSigns	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 ukcore-obs-vs-001: `code.coding` SHALL include a LOINC "magic code"
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
bodyPosition		0..1	(Complex)	The patients body position when the vital signs observation was recorded. URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/observation-bodyPosition"
value[x]		1..1	CodeableConcept	Value of extension Binding: UK Core Body Position (preferred)
recordingSetting		0..*	CodeableConcept	Records whether the vital signs observation was performed in a clinical or non clinical setting. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-RecordingSetting
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	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	A status of `final` SHALL be present. Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
category	S	1..1	CodeableConcept	A category of `vital-signs` SHALL be present. Binding: ObservationCategoryCodes (required): Codes for high level observation categories.
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version	Σ	0..1	string	Version of the system - if relevant
code	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 vital signs observation (code / type). Binding: UK Core Observation Vital Signs Type (preferred)
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:loinc	Σ	1..1	Coding	A LOINC "magic code" describing the type of observation SHALL be present. Binding: VitalSigns (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
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
coding:snomedCT	Σ	1..*	Coding	A SNOMED CT concept describing the type of observation SHALL be present. Binding: UK Core Observation Vital Signs Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of 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
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
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
subject	SΣ	1..1	Reference(InterweavePatient)	Who or what the observation relates to SHALL be present.
extension		0..0
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.
id		0..1	string	Unique id for inter-element referencing
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	Quantity	The actual observed result.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (preferred): Methods for simple observations.
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device)	(Measurement) Device
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
derivedFrom	Σ	0..*	Reference(InterweaveObservation | InterweaveQuestionnaireResponse)	Related measurements the observation is made from
component	SΣ	0..*	BackboneElement	Component / sub results.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
valuePrecision		0..1	integer	Explicit precision (number of significant decimal places) URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component 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..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
value[x]	SΣ	0..1	Quantity	Actual component result
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
referenceRange	S	0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
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.extension:bodyPosition.value[x]	preferred	UKCoreBodyPosition https://fhir.hl7.org.uk/ValueSet/UKCore-BodyPosition from this IG
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	required	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.code.coding:loinc	extensible	VitalSigns http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.code.coding:snomedCT	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Observation.performer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site 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	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	required	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-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.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()
ukcore-obs-vs-001	error	Observation	`code.coding` SHALL include a LOINC "magic code" : code.coding.where(system='http://loinc.org').exists()

Differential View

This structure is derived from UKCoreObservationVitalSigns

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	UKCoreObservationVitalSigns	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
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
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		1..1	CodeableConcept	A category of `vital-signs` SHALL be present. Binding: ObservationCategoryCodes (required): Codes for high level observation categories.
id		0..0
extension		0..0
coding
id		0..0
extension		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 Fixed Value: Vital Signs
code		1..1	CodeableConcept	The type of vital signs observation (code / type). Binding: UK Core Observation Vital Signs Type (preferred)
id		0..0
Slices for coding				Content/Rules for all slices
coding:loinc		1..1	Coding	A LOINC "magic code" describing the type of observation SHALL be present.
version		0..0
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:snomedCT		1..*	Coding	A SNOMED CT concept describing the type of observation SHALL be present.
version		0..0
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
subject		1..1	Reference(InterweavePatient)	Who or what the observation relates to SHALL be present.
id		0..0
extension		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.
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	Quantity	The actual observed result.
dataAbsentReason	S	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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
note	S	0..1	Annotation	Comments about the observation
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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
method
id		0..0
extension		0..0
coding
id		0..0
extension		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
device		0..1	Reference(Device)	(Measurement) Device
referenceRange	S	0..*	BackboneElement	Provides guide for interpretation
id		0..0
extension		0..0
hasMember		0..0
derivedFrom		0..*	Reference(InterweaveObservation | InterweaveQuestionnaireResponse)	Related measurements the observation is made from
component
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
valuePrecision		0..1	integer	Explicit precision (number of significant decimal places) URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
code	S	1..1	CodeableConcept	Type of component observation (code / type)
id		0..0
extension		0..0
coding
id		0..0
extension		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
value[x]	S	0..1	Quantity	Actual component result
dataAbsentReason	S	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
id		0..0
extension		0..0
coding
id		0..0
extension		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
referenceRange	S	0..*		Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.category	required	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.component.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	UKCoreObservationVitalSigns	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 ukcore-obs-vs-001: `code.coding` SHALL include a LOINC "magic code"
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
bodyPosition		0..1	(Complex)	The patients body position when the vital signs observation was recorded. URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/observation-bodyPosition"
value[x]		1..1	CodeableConcept	Value of extension Binding: UK Core Body Position (preferred)
recordingSetting		0..*	CodeableConcept	Records whether the vital signs observation was performed in a clinical or non clinical setting. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-RecordingSetting
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
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	A status of `final` SHALL be present. Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
category	S	1..1	CodeableConcept	A category of `vital-signs` SHALL be present. Binding: ObservationCategoryCodes (required): Codes for high level observation categories.
extension		0..0
code	SΣ	1..1	CodeableConcept	The type of vital signs observation (code / type). Binding: UK Core Observation Vital Signs Type (preferred)
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:loinc	Σ	1..1	Coding	A LOINC "magic code" describing the type of observation SHALL be present. Binding: VitalSigns (extensible)
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	1..*	Coding	A SNOMED CT concept describing the type of observation SHALL be present. Binding: UK Core Observation Vital Signs Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
subject	SΣ	1..1	Reference(InterweavePatient)	Who or what the observation relates to SHALL be present.
extension		0..0
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	Quantity	The actual observed result.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (required)
extension		0..0
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
note	S	0..1	Annotation	Comments about the observation
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (required)
extension		0..0
device		0..1	Reference(Device)	(Measurement) Device
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
derivedFrom	Σ	0..*	Reference(InterweaveObservation | InterweaveQuestionnaireResponse)	Related measurements the observation is made from
component	SΣ	0..*	BackboneElement	Component / sub results.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
valuePrecision		0..1	integer	Explicit precision (number of significant decimal places) URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component 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..0
value[x]	SΣ	0..1	Quantity	Actual component result
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (required)
extension		0..0
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
referenceRange	S	0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
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.extension:bodyPosition.value[x]	preferred	UKCoreBodyPosition https://fhir.hl7.org.uk/ValueSet/UKCore-BodyPosition from this IG
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	required	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.code.coding:loinc	extensible	VitalSigns http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.code.coding:snomedCT	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.component.code	preferred	UKCoreObservationType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType from this IG
Observation.component.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	required	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-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.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()
ukcore-obs-vs-001	error	Observation	`code.coding` SHALL include a LOINC "magic code" : code.coding.where(system='http://loinc.org').exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	UKCoreObservationVitalSigns	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 ukcore-obs-vs-001: `code.coding` SHALL include a LOINC "magic code"
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
bodyPosition		0..1	(Complex)	The patients body position when the vital signs observation was recorded. URL: http://hl7.org/fhir/StructureDefinition/observation-bodyPosition
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/observation-bodyPosition"
value[x]		1..1	CodeableConcept	Value of extension Binding: UK Core Body Position (preferred)
recordingSetting		0..*	CodeableConcept	Records whether the vital signs observation was performed in a clinical or non clinical setting. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-RecordingSetting
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	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	A status of `final` SHALL be present. Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
category	S	1..1	CodeableConcept	A category of `vital-signs` SHALL be present. Binding: ObservationCategoryCodes (required): Codes for high level observation categories.
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version	Σ	0..1	string	Version of the system - if relevant
code	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 vital signs observation (code / type). Binding: UK Core Observation Vital Signs Type (preferred)
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:loinc	Σ	1..1	Coding	A LOINC "magic code" describing the type of observation SHALL be present. Binding: VitalSigns (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
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
coding:snomedCT	Σ	1..*	Coding	A SNOMED CT concept describing the type of observation SHALL be present. Binding: UK Core Observation Vital Signs Type (preferred): A code from the SNOMED Clinical Terminology UK coding system describing a type of 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
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
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
subject	SΣ	1..1	Reference(InterweavePatient)	Who or what the observation relates to SHALL be present.
extension		0..0
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.
id		0..1	string	Unique id for inter-element referencing
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	Quantity	The actual observed result.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (preferred): Methods for simple observations.
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device)	(Measurement) Device
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
derivedFrom	Σ	0..*	Reference(InterweaveObservation | InterweaveQuestionnaireResponse)	Related measurements the observation is made from
component	SΣ	0..*	BackboneElement	Component / sub results.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
valuePrecision		0..1	integer	Explicit precision (number of significant decimal places) URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component 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..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
value[x]	SΣ	0..1	Quantity	Actual component result
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
interpretation	S	0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
extension		0..0
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
referenceRange	S	0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
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.extension:bodyPosition.value[x]	preferred	UKCoreBodyPosition https://fhir.hl7.org.uk/ValueSet/UKCore-BodyPosition from this IG
Observation.status	required	Fixed Value: final http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	required	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.code.coding:loinc	extensible	VitalSigns http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.code.coding:snomedCT	preferred	UKCoreObservationVitalSignsType https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationVitalSignsType from this IG
Observation.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Observation.performer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Observation.dataAbsentReason	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site 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	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	required	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-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.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()
ukcore-obs-vs-001	error	Observation	`code.coding` SHALL include a LOINC "magic code" : code.coding.where(system='http://loinc.org').exists()

This structure is derived from UKCoreObservationVitalSigns

Summary

Mandatory: 6 elements(32 nested mandatory elements)
Must-Support: 21 elements
Fixed: 3 elements
Prohibited: 48 elements

Structures

This structure refers to these other structures:

• InterweavePatient (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Patient)
• InterweaveEncounter (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Encounter)
• InterweaveObservation (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Observation)
• InterweaveQuestionnaireResponse (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-QuestionnaireResponse)

Extensions

This structure refers to these extensions:

• https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-ValuePrecision

Slices

This structure defines the following Slices:

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