Status: Active: Approved (STU)

Introduction

This profile sets out the expectations for the interweave blood pressure observation resource. The base for this profile is the CareConnect-BloodPressure-Observation-1 and we have made little adjustment to this base profile. We have enforced the use of SNOMED codes where possible.

Mandatory fields

The following mandatory fields are defined:

1. status – Fixed value of ‘final’.

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

3. code – Fixed value of SCT:75367002 (Blood Pressure).

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. component – The component field contains two slices, one which represents the systolic measurement and the other the diastolic. Both components must be populated, unless the dataAbsentReason is populated. Both slices have fixed SNOMED values for the code field, and the result must be populated into the valueQuantity field.

2. 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.

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

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

5. 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.

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

7. 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.

• bodySite – A long list of SNOMED codes which represent the observed parts of the body.

• 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.

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.

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

This structure is derived from CareConnect-BloodPressure-Observation-1

Name	Flags	Card.	Type	Description & Constraints
​ Observation		0..*	CareConnect-BloodPressure-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
​ 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
​ identifier	S	0..*	Identifier	Business Identifier for observation
​ basedOn		0..*	Reference(CareConnect-CarePlan-1 | DeviceRequest | ImmunizationRecommendation | CareConnect-MedicationRequest-1 | NutritionOrder | CareConnect-ReferralRequest-1 | CareConnect-ProcedureRequest-1)	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		1..1	code	Fixed value of ‘final’.
​ category		1..1	CodeableConcept	Classification of type of observation
​ coding
​ display		1..1	string	Representation defined by the system
​ subject		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]		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]		0..0
value[x]:valueQuantity		0..0
​ dataAbsentReason		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		0..*	BackboneElement	Resources related to this observation
​ type	S	1..1	code	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		0..2	BackboneElement	Used when reporting systolic and diastolic blood pressure.
​ component:systolicComponent	S	1..1	BackboneElement	Component results
​ code
​ coding:loinc		1..1	Coding	Systolic Blood Pressure
​ display		1..1	string	Representation defined by the system Fixed Value: Systolic blood pressure
​ coding:snomedCT		1..1	Coding	Systolic Blood Pressure
extension		0..0
extension:snomedCTDescriptionID		0..0
​ code		1..1	code	Symbol in syntax defined by the system Fixed Value: 271649006
​ display		1..1	string	Representation defined by the system Fixed Value: Systolic blood pressure
​ component:diastolicComponent	S	1..1	BackboneElement	Component results
​ code
​ coding:loinc		1..1	Coding	Diastolic Blood Pressure
​ display		1..1	string	Representation defined by the system Fixed Value: Diastolic blood pressure
​ coding:snomedCT		1..1	Coding	Diastolic Blood Pressure
extension		0..0
extension:snomedCTDescriptionID		0..0
​ code		1..1	code	Symbol in syntax defined by the system Fixed Value: 271650006
​ display		1..1	string	Representation defined by the system Fixed Value: Diastolic blood pressure
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
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

Name	Flags	Card.	Type	Description & Constraints
​ Observation	C	0..*	CareConnect-BloodPressure-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
​ 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
​ 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(CareConnect-CarePlan-1 | DeviceRequest | ImmunizationRecommendation | CareConnect-MedicationRequest-1 | NutritionOrder | CareConnect-ReferralRequest-1 | CareConnect-ProcedureRequest-1)	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	Fixed value of ‘final’. Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
​ category	S	1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required)
​ coding	Σ	1..1	Coding	Code defined by a terminology system
​ 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 Fixed Value: vital-signs
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Vital Signs
​ code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types.
​ Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:code
​ coding:loinc	Σ	1..1	Coding	Code defined by a terminology system Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ 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 Fixed Value: 85354-9
​ coding:snomedCT	Σ	1..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 Fixed Value: 75367002
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Blood pressure
​ 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
​ 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 Binding: Care Connect Body Site (preferred): A code from the SNOMED Clinical Terminology UK with the expression (<<442083009 |anatomical or acquired body structure|).
​ 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 Binding: Care Connect Observation Method (preferred): A code from SNOMED Clinical Terminology UK
​ 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	Fixed value: derived-from Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: has-member
​ 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.
​ Slices for component	Σ	0..2	BackboneElement	Used when reporting systolic and diastolic blood pressure. Slice: Unordered, Open by value:code
component:All Slices				Content/Rules for all slices
​ modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
​ code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINC Codes (example): Codes identifying names of simple observations.
​ component:systolicComponent	SΣ	1..1	BackboneElement	Component results
​ modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
​ code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types.
​ Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:code
​ coding:loinc	Σ	1..1	Coding	Systolic Blood Pressure Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ 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 Fixed Value: 8480-6
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Systolic blood pressure
​ coding:snomedCT	Σ	1..1	Coding	Systolic Blood Pressure
​ Slices for extension		0..0
​ 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 Fixed Value: 271649006
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Systolic blood pressure
​ value[x]:valueQuantity	Σ	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): A value set describing common UCUM units for recording vital signs
​ value	Σ	1..1	decimal	Numerical value (with implicit precision)
​ comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
​ unit	Σ	1..1	string	Unit representation
​ system	ΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
​ code	Σ	1..1	code	Coded responses from the common UCUM units for vital signs value set. Fixed Value: mm[Hg]
​ component:diastolicComponent	SΣ	1..1	BackboneElement	Component results
​ modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
​ code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:code
​ coding:loinc	Σ	1..1	Coding	Diastolic Blood Pressure Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ 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 Fixed Value: 8462-4
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Diastolic blood pressure
​ coding:snomedCT	Σ	1..1	Coding	Diastolic Blood Pressure
​ Slices for extension		0..0
​ 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 Fixed Value: 271650006
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Diastolic blood pressure
​ value[x]:valueQuantity	Σ	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): A value set describing common UCUM units for recording vital signs
​ value	Σ	1..1	decimal	Numerical value (with implicit precision)
​ comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
​ unit	Σ	1..1	string	Unit representation
​ system	ΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
​ code	Σ	1..1	code	Coded responses from the common UCUM units for vital signs value set. Fixed Value: mm[Hg]
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	Fixed Value: final
Observation.category	required	Observation Category Codes
Observation.code	extensible	Vital Signs
Observation.code.coding:loinc	extensible	Fixed Value: LOINC code 85354-9
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator
Observation.value[x]:valueQuantity.code	required	Vital Signs Units
Observation.dataAbsentReason	required	Observation Value Absent Reason
Observation.interpretation	required	Observation Interpretation Codes
Observation.bodySite	required	SNOMED CT Body Structures
Observation.bodySite.coding:snomedCT	preferred	Care Connect Body Site
Observation.method	preferred	Observation Methods
Observation.method.coding:snomedCT	preferred	Care Connect Observation Method
Observation.related.type	required	Fixed Value: has-member
Observation.component.code	example	LOINC Codes (a valid code from LOINC)
Observation.component:systolicComponent.code	extensible	Vital Signs
Observation.component:systolicComponent.code.coding:loinc	extensible	Fixed Value: LOINC code 8480-6
Observation.component:systolicComponent.value[x]:valueQuantity	required	Vital Signs Units
Observation.component:systolicComponent.value[x]:valueQuantity.comparator	required	QuantityComparator
Observation.component:diastolicComponent.code	extensible	Vital Signs
Observation.component:diastolicComponent.code.coding:loinc	extensible	Fixed Value: LOINC code 8462-4
Observation.component:diastolicComponent.value[x]:valueQuantity	required	Vital Signs Units
Observation.component:diastolicComponent.value[x]:valueQuantity.comparator	required	QuantityComparator

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	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (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 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-BloodPressure-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
​ 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(CareConnect-CarePlan-1 | DeviceRequest | ImmunizationRecommendation | CareConnect-MedicationRequest-1 | NutritionOrder | CareConnect-ReferralRequest-1 | CareConnect-ProcedureRequest-1)	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	Fixed value of ‘final’. Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
​ category	S	1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (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	1..1	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 Fixed Value: http://hl7.org/fhir/observation-category
​ code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Vital Signs
​ userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
​ text	Σ	0..1	string	Plain text representation of the concept
​ code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types.
​ 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	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:code
​ coding:loinc	Σ	1..1	Coding	Code defined by a terminology system Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ 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://loinc.org
​ 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: 85354-9
​ display	Σ	0..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..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 Fixed Value: 75367002
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Blood pressure
​ 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
​ 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 Binding: Care Connect Body Site (preferred): A code from the SNOMED Clinical Terminology UK with the expression (<<442083009 |anatomical or acquired body structure|).
​ 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 Binding: Care Connect Observation Method (preferred): A code from SNOMED Clinical Terminology UK
​ 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	Fixed value: derived-from Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: has-member
​ 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.
​ Slices for component	Σ	0..2	BackboneElement	Used when reporting systolic and diastolic blood pressure. Slice: Unordered, Open by value:code
component: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
​ modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
​ code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINC Codes (example): Codes identifying names of simple observations.
​ value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueAttachment			Attachment
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
​ component:systolicComponent	SΣ	1..1	BackboneElement	Component results
​ 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
​ code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types.
​ 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:code
​ coding:loinc	Σ	1..1	Coding	Systolic Blood Pressure Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ 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://loinc.org
​ 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: 8480-6
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Systolic blood pressure
​ userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
​ coding:snomedCT	Σ	1..1	Coding	Systolic Blood Pressure
​ id		0..1	string	xml:id (or equivalent in JSON)
​ Slices for extension		0..0
​ 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 Fixed Value: 271649006
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Systolic blood pressure
​ 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]:valueQuantity	Σ	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): A value set describing common UCUM units for recording vital signs
​ id		0..1	string	xml:id (or equivalent in JSON)
​ extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
​ value	Σ	1..1	decimal	Numerical value (with implicit precision)
​ comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
​ unit	Σ	1..1	string	Unit representation
​ system	ΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
​ code	Σ	1..1	code	Coded responses from the common UCUM units for vital signs value set. Fixed Value: mm[Hg]
​ 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
​ component:diastolicComponent	SΣ	1..1	BackboneElement	Component results
​ 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
​ code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ 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:code
​ coding:loinc	Σ	1..1	Coding	Diastolic Blood Pressure Binding: Vital Signs (extensible): This value set indicates the allowed vital sign result types
​ 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://loinc.org
​ 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: 8462-4
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Diastolic blood pressure
​ userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
​ coding:snomedCT	Σ	1..1	Coding	Diastolic Blood Pressure
​ id		0..1	string	xml:id (or equivalent in JSON)
​ Slices for extension		0..0
​ 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 Fixed Value: 271650006
​ display	Σ	1..1	string	Representation defined by the system Fixed Value: Diastolic blood pressure
​ 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]:valueQuantity	Σ	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): A value set describing common UCUM units for recording vital signs
​ id		0..1	string	xml:id (or equivalent in JSON)
​ extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
​ value	Σ	1..1	decimal	Numerical value (with implicit precision)
​ comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
​ unit	Σ	1..1	string	Unit representation
​ system	ΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
​ code	Σ	1..1	code	Coded responses from the common UCUM units for vital signs value set. Fixed Value: mm[Hg]
​ 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	Fixed Value: final
Observation.category	required	Observation Category Codes
Observation.code	extensible	Vital Signs
Observation.code.coding:loinc	extensible	Fixed Value: LOINC code 85354-9
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator
Observation.value[x]:valueQuantity.code	required	Vital Signs Units
Observation.dataAbsentReason	required	Observation Value Absent Reason
Observation.interpretation	required	Observation Interpretation Codes
Observation.bodySite	required	SNOMED CT Body Structures
Observation.bodySite.coding:snomedCT	preferred	Care Connect Body Site
Observation.method	preferred	Observation Methods
Observation.method.coding:snomedCT	preferred	Care Connect Observation Method
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: has-member
Observation.component.code	example	LOINC Codes (a valid code from LOINC)
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason
Observation.component.interpretation	extensible	Observation Interpretation Codes
Observation.component:systolicComponent.code	extensible	Vital Signs
Observation.component:systolicComponent.code.coding:loinc	extensible	Fixed Value: LOINC code 8480-6
Observation.component:systolicComponent.value[x]:valueQuantity	required	Vital Signs Units
Observation.component:systolicComponent.value[x]:valueQuantity.comparator	required	QuantityComparator
Observation.component:systolicComponent.dataAbsentReason	extensible	Observation Value Absent Reason
Observation.component:systolicComponent.interpretation	extensible	Observation Interpretation Codes
Observation.component:diastolicComponent.code	extensible	Vital Signs
Observation.component:diastolicComponent.code.coding:loinc	extensible	Fixed Value: LOINC code 8462-4
Observation.component:diastolicComponent.value[x]:valueQuantity	required	Vital Signs Units
Observation.component:diastolicComponent.value[x]:valueQuantity.comparator	required	QuantityComparator
Observation.component:diastolicComponent.dataAbsentReason	extensible	Observation Value Absent Reason
Observation.component:diastolicComponent.interpretation	extensible	Observation Interpretation Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (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()