Status: Active: Approved (STU)

Introduction

This profile sets out the expectations for the interweave observation resource. Our profile models measurements and simple assertions which are made about a patient. Modelling observations can be quite complex. This is due to the way in which result formats vary for the different types of observation. In line with care connect, this has led us to design specific profiles for the some of the most commonly recorded/shared observation types such as blood pressure; heart rate; NEWS 2 score etc (see the artifacts section for the full list). We are aware at that we will not have modelled every type of observation, if you identify a type of observation, which you believe requires a specific profile, then please get in touch.

This profile can be used to represent observations which are perhaps less common or were no specific profile exists and is under development. But the “type” specific profiles should be used where possible, to aid the data consumer. Only finalised observations should be provided for the shared care record.

Mandatory fields

The following mandatory fields are defined:

1. status – We use the required binding supplied by care connect for the observation status. As stated in the introduction, only finalised observations should be shared. We do also allow for amendments and corrections to the final observation to take place. We therefore limit the list of statuses which can be used to the following - final; amended; corrected
2. category – The classification of the type of observation e.g. exam, survey, vital-signs etc. We require that the FHIR Observation category is always populated. There is also an option to provide additional local categories to enable FHIR searching on local categories.
3. code – This is the type of observation. We state a preferred binding on this field of the SNOMED concept: 363788007 (observable entity). This is in recognition of the large amount of local code sets which are currently in use and the difficulties which data providers may have mapping their local codes to SNOMED. Should you wish to use a local code set to populate this field, as detailed in the conformance section of this implementation guide, you must contact us for explicit approval to do so.
4. subject – Every observation must be linked to a patient.
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. value[x] – Is used to house simple results. 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. Inline with R4, we have removed the valueAttachment field and pre-adopted the valueInteger field.

2. 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. As with the value[x] field, we have removed the valueAttachment field and pre-adopted the valueInteger field, to be inline with R4.

3. 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.

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

5. performer - We limit this field to reference practitioner resources only. The organization responsible for the observation can be obtained via the provenance tag.

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

7. 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.

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

9. comment - 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.

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:

• reasonCondition (care connect extension) - An optional care connect extension that allows the reason for an observation being performed/recorded to be specified. This can be a reference to a condition resource or a coded entity.

• context – Optional link to an encounter resource.
• 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.
• related – To reduce complexity, we limit the related field’s usage to only allow links to observation 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.
• Extension-Interweave-valuePrecision – 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.
• 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.
• valueAttachment – in line with R4 we have removed this child field from both value[x] and component.value[x]

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

This structure is derived from CareConnect-Observation-1

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	CareConnect-Observation-1	Measurements and simple assertions
id	S	0..1	id	Logical id of this artifact
meta
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..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
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
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
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
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-ValuePrecision
identifier	S	0..*	Identifier	Business Identifier for observation
basedOn		0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)	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	S	1..1	code	Only finalised observations should be shared. We do also allow for amendments and corrections to the final observation to take place. We therefore limit the list of statuses which can be used to the following - final | amended | corrected Binding: ObservationStatus (required)
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.system
category:All Slices				Content/Rules for all slices
coding		0..*	Coding	Code defined by a terminology system
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
category:observationCategory		1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required): Codes for high level observation categories.
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category
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		0..0
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: Care Connect Observation Type (preferred)
coding		0..*	Coding	Code defined by a terminology system
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
coding:snomedCT	S	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
subject	S	1..1	Reference(CareConnectPatient1)	The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.
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
context		0..1	Reference(CareConnect-Encounter-1)	The encounter during which this observation is made.
effective[x]	S	1..1	dateTime, Period	This is the time/time period during which the observation was taken.
issued		0..0
performer	S	0..*	Reference(CareConnect-Practitioner-1)	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]	S	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	S	0..1	CodeableConcept	Why the result is missing Binding: Observation Value Absent Reason (required)
coding
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..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (required)
comment	S	0..1	string	Comments about the result
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMED CT Body Structures (required)
method		0..1	CodeableConcept	How it was done Binding: Observation Methods (preferred)
coding		0..*	Coding	Code defined by a terminology system
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..1	Reference(CareConnect-Specimen-1)	Specimen used for this observation.
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
device		0..1	Reference(Device)	Measurement device.
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
referenceRange	S	0..*	BackboneElement	Provides guide for interpretation
related	S	0..*	BackboneElement	Resources related to this observation
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Fixed Value: derived-from
target	S	1..1	Reference(CareConnect-Observation-1)	we limit the related field’s usage to only allow links to observation 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.
component	S	0..*	BackboneElement	Component 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.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-ValuePrecision
code	S	1..1	CodeableConcept	Type of component observation (code / type) Binding: Care Connect Observation Type (preferred)
coding		0..*	Coding	Code defined by a terminology system
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
coding:snomedCT	S	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
value[x]	S	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.status	required	ObservationStatus
Observation.category:observationCategory	required	Observation Category Codes
Observation.code	preferred	Care Connect Observation Type
Observation.code.coding:snomedCT	preferred	Care Connect Observation Type
Observation.dataAbsentReason	required	Observation Value Absent Reason
Observation.interpretation	required	Observation Interpretation Codes
Observation.bodySite	required	SNOMED CT Body Structures
Observation.method	preferred	Observation Methods
Observation.component.code	preferred	Care Connect Observation Type
Observation.component.code.coding:snomedCT	preferred	Care Connect Observation Type

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	CareConnect-Observation-1	Measurements and simple assertions
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..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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: Common Tags (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: Common Tags (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://yhcr.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: Common Tags (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://yhcr.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: Common Languages (extensible): 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
reason		0..*	CodeableConcept, Reference(CareConnect-Condition-1)	Reason resource added/performed/given URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-ReasonCondition-1
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-ValuePrecision
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 (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)	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	Only finalised observations should be shared. We do also allow for amendments and corrections to the final observation to take place. We therefore limit the list of statuses which can be used to the following - final | amended | corrected Binding: ObservationStatus (required)
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.system Binding: Observation Category Codes (preferred): Codes for high level observation categories.
category:All Slices				Content/Rules for all slices
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
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	0..1	Coding	Code defined by a terminology system
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
category:observationCategory		1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required): Codes for high level observation categories.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Care Connect Observation Type (preferred)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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(CareConnectPatient1)	The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.
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
context		0..1	Reference(CareConnect-Encounter-1)	The encounter 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
performer	SΣ	0..*	Reference(CareConnect-Practitioner-1)	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		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: Observation Value Absent Reason (required)
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (required)
comment	S	0..1	string	Comments about the result
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMED CT Body Structures (required)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
method		0..1	CodeableConcept	How it was done Binding: Observation Methods (preferred)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
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	0..1	Coding	Code defined by a terminology system
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
specimen		0..1	Reference(CareConnect-Specimen-1)	Specimen used for this 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	0..1	string	If relevant, description of the referenced resource
device		0..1	Reference(Device)	Measurement device.
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	0..1	string	If relevant, description of the referenced resource
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
related	SΣ	0..*	BackboneElement	Resources related to this observation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: derived-from
target	S	1..1	Reference(CareConnect-Observation-1)	we limit the related field’s usage to only allow links to observation 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.
component	SΣ	0..*	BackboneElement	Component 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.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Care Connect Observation Type (preferred)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
value[x]	SΣ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.meta.security	extensible	All Security Labels
Observation.meta.tag	example	Common Tags
Observation.meta.tag:Source	example	Common Tags
Observation.meta.tag:Provenance	example	Common Tags
Observation.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Observation.identifier.use	required	IdentifierUse
Observation.status	required	ObservationStatus
Observation.category	preferred	Observation Category Codes
Observation.category:observationCategory	required	Observation Category Codes
Observation.code	preferred	Care Connect Observation Type
Observation.code.coding:snomedCT	preferred	Care Connect Observation Type
Observation.dataAbsentReason	required	Observation Value Absent Reason
Observation.interpretation	required	Observation Interpretation Codes
Observation.bodySite	required	SNOMED CT Body Structures
Observation.method	preferred	Observation Methods
Observation.related.type	required	Fixed Value: derived-from
Observation.component.code	preferred	Care Connect Observation Type
Observation.component.code.coding:snomedCT	preferred	Care Connect Observation Type

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
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 : contained.where(('#'+id in %resource.descendants().reference).not()).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()
ele-1	error	Observation.extension:reason, Observation.referenceRange, Observation.related, Observation.component, Observation.component.extension:valuePrecision	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	Observation.extension:reason, Observation.component.extension:valuePrecision	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 code is the same as a component code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	CareConnect-Observation-1	Measurements and simple assertions
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
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.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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: Common Tags (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: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
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://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
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: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
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://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
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: Common Languages (extensible): 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
reason		0..*	CodeableConcept, Reference(CareConnect-Condition-1)	Reason resource added/performed/given URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-ReasonCondition-1
valuePrecision		0..1	integer	Explicit precision of the number URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Business Identifier for observation
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (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	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..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(CareConnect-Organization-1)	Organization that issued id (may be just text)
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)	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	Only finalised observations should be shared. We do also allow for amendments and corrections to the final observation to take place. We therefore limit the list of statuses which can be used to the following - final | amended | corrected Binding: ObservationStatus (required)
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.system Binding: Observation Category Codes (preferred): Codes for high level observation categories.
category:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
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
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
category:observationCategory		1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required): Codes for high level observation categories.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
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://hl7.org/fhir/observation-category
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
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Care Connect Observation Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
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
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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(CareConnectPatient1)	The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.
id		0..1	string	xml:id (or equivalent in JSON)
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)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context		0..1	Reference(CareConnect-Encounter-1)	The encounter 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
performer	SΣ	0..*	Reference(CareConnect-Practitioner-1)	Who is responsible for the observation.
id		0..1	string	xml:id (or equivalent in JSON)
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)
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		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: Observation Value Absent Reason (required)
id		0..1	string	xml:id (or equivalent in JSON)
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	xml:id (or equivalent in JSON)
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
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (required)
comment	S	0..1	string	Comments about the result
bodySite	S	0..1	CodeableConcept	Observed body part Binding: SNOMED CT Body Structures (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
method		0..1	CodeableConcept	How it was done Binding: Observation Methods (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
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
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
specimen		0..1	Reference(CareConnect-Specimen-1)	Specimen used for this observation.
id		0..1	string	xml:id (or equivalent in JSON)
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)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
device		0..1	Reference(Device)	Measurement device.
id		0..1	string	xml:id (or equivalent in JSON)
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)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
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: Observation Reference Range Meaning Codes (extensible): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: Observation Reference Range Applies To Codes (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
related	SΣ	0..*	BackboneElement	Resources related to this observation
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: derived-from
target	S	1..1	Reference(CareConnect-Observation-1)	we limit the related field’s usage to only allow links to observation 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.
component	SΣ	0..*	BackboneElement	Component results
id		0..1	string	xml:id (or equivalent in JSON)
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.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-ValuePrecision
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Care Connect Observation Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
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
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
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
value[x]	SΣ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.meta.security	extensible	All Security Labels
Observation.meta.tag	example	Common Tags
Observation.meta.tag:Source	example	Common Tags
Observation.meta.tag:Provenance	example	Common Tags
Observation.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Observation.identifier.use	required	IdentifierUse
Observation.identifier.type	extensible	Identifier Type Codes
Observation.status	required	ObservationStatus
Observation.category	preferred	Observation Category Codes
Observation.category:observationCategory	required	Observation Category Codes
Observation.code	preferred	Care Connect Observation Type
Observation.code.coding:snomedCT	preferred	Care Connect Observation Type
Observation.dataAbsentReason	required	Observation Value Absent Reason
Observation.interpretation	required	Observation Interpretation Codes
Observation.bodySite	required	SNOMED CT Body Structures
Observation.method	preferred	Observation Methods
Observation.referenceRange.type	extensible	Observation Reference Range Meaning Codes
Observation.referenceRange.appliesTo	example	Observation Reference Range Applies To Codes
Observation.related.type	required	Fixed Value: derived-from
Observation.component.code	preferred	Care Connect Observation Type
Observation.component.code.coding:snomedCT	preferred	Care Connect Observation Type
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason
Observation.component.interpretation	extensible	Observation Interpretation Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	Observation.extension:reason, Observation.referenceRange, Observation.related, Observation.component, Observation.component.extension:valuePrecision	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	Observation.extension:reason, Observation.component.extension:valuePrecision	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()