eHealth Infrastructure (v1.0.0)

StructureDefinition: ehealth-observation

Introduction

An Observation contains the result of a measurement performed by the Patient. It is based on a ProcedureRequest that contains information about what to measure and when to measure.

In addition to the result and context, the Observation also contains information about the device used to perform the measurement and reference ranges copied from the ProcedureRequest. Reference ranges can change over time, so the copy ensures that the reference range at the time of measurement is preserved.

The eHealth Infrastructure will assist in calculating qualities of the measurement. The observation will be annotated with these qualities.

Scope and Usage

In the eHealth Infrastructure the Observation resource is used in conjunction with the following resources.

  • Media
    • Some Observations may be accompanied by media. E.g. images.
  • QuestionnaireResponse
    • Some activities may involve answering a Questionnaire. The answer is captured in a QuestionnaireResponse. Questionnaires can be used for standalone information about the health of the patient, or they can be used to provide context information for Observations.
  • Communication
    • Communication resources can be used to annotate Observations. Recipient controls who has access to the annotations.
  • Provenance
    • In certain circumstances data from Observations and QuestionnaireResponses can be reused. When this happens, a Provenance resource will identify the source of the original data.
    • Provenance is also used to link correlated resources submitted together.

Submitting Observation bundles

Observations can be submitted using the submit-measurement operation. It is possible to submit a bundle of related resources containing:

  • Observations
  • Media
  • QuestionnaireResponses
  • Communications
  • Provenances

The submit-measurement operation is intended for uploading single measurements, not bulk uploads. Uploading large batches of resources is considered misuse.

The entire bundle is validated and then saved in a single transaction.

Observations are generally immutable once the bundle is saved. Further information about the observation can be added in separate resources like Provenance and Communication.

Marking Observations as “reused”

When a submitted Observation is actually reuse of a previous measurement, this must be marked by the submitter by added a Provenance resource with certain pre-defined properties.

  • Provenance
    • .target must reference all reused resources in the submitted bundle; e.g. the Observation, QuestionnaireResponse or Media containing a copy of the reused values.
    • .activity must have value “Quotation” (“wasQuotedFrom”) from FHIR ValueSet https://www.hl7.org/fhir/stu3/codesystem-w3c-provenance-activity-type.html#w3c-provenance-activity-type-Quotation
    • .policy must have value “http://ehealth.sundhed.dk/policy/ehealth/reuse-by-patient”
    • .agent.whoReference must reference the Patient who decided to reuse
    • .entity.role = “quotation”
    • .entity.what = must be reference to Observation, QuestionnaireResponse or Media being reused.

The Provenance resource needs not be supplied for resources which are not being used. However, for non-reused resources, a Provenance resource with .activity = “Primary-Source” can be used to indicate a newly obtained (not reused) Observation, QuestionnaireResponse or Media.

Marking Resources submitted in same bundle

When an Observation-bundle is submitted the eHealth Infrastructure will automatically create a Provenance resource, which identifies the resources which were submitted in the same bundle.

The search-measurements operation can return the resources submitted as part of the same bundle.

Searching for Observations

It is possible to search for Observations based on:

  • context
  • subject
  • code
  • period
  • deviceMeasuringQuality
  • situationQuality
  • operationQuality

At least one of “subject” and “context” must be provided. “period” searches on range of “effective”.

See Searching for more information about searching in REST, messaging, and services.

Formal Views of Profile Content

The official URL for this profile is: 

http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-observation

This profile builds on Observation.

This profile was published on Wed Mar 06 14:43:56 UTC 2019 as a draft by ehealth.sundhed.dk.

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

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*Measurements and simple assertions made about a patient, device or other subject.
... extension 0..*ExtensionSlice: Unordered, Open by value:url
... ehealth-quality 0..*(Complex)Minimum requirements for qualities
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... ehealth-sharingPolicy 1..1CodingExtension
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-sharingPolicy
Binding: SubmissionSharingPolicies (required)
... basedOn 1..1Reference(eHealth ProcedureRequest)Fulfills procedure request.
... code 1..1CodeableConceptBinding: ObservationCodes (required)
... subject 1..1Reference(eHealth Patient)
... context 1..1Reference(eHealth EpisodeOfCare)
... effective[x] 1..1dateTime, Period
... performer 1..1Reference(eHealth Practitioner | eHealth Organization | eHealth Patient | eHealth RelatedPerson)
... value[x] 0..1Quantity, CodeableConcept
... device 1..1Reference(eHealth Device)
... referenceRange 0..*BackboneElement
.... low 0..1SimpleQuantity
.... high 0..1SimpleQuantity

doco Documentation for this format

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*Measurements and simple assertions made about a patient, device or other subject.
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ehealth-quality 0..*(Complex)Extension
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... ehealth-sharingPolicy 1..1CodingExtension
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-sharingPolicy
Binding: SubmissionSharingPolicies (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ1..1Reference(eHealth ProcedureRequest)Fulfills procedure request.
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category 0..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
... code Σ1..1CodeableConceptType of observation (code / type)
Binding: ObservationCodes (required)
... subject Σ1..1Reference(eHealth Patient)Who and/or what this is about
... context 1..1Reference(eHealth EpisodeOfCare)Healthcare event during which this observation is made
... effective[x] Σ1..1dateTime, PeriodClinically relevant time/time-period for observation
... issued Σ0..1instantDate/Time this was made available
... performer Σ1..1Reference(eHealth Practitioner | eHealth Organization | eHealth Patient | eHealth RelatedPerson)Who is responsible for the observation
... value[x] ΣI0..1Quantity, CodeableConceptActual result
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method 0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 1..1Reference(eHealth Device)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... related ΣI0..*BackboneElementResource related to this observation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 0..1codehas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
Binding: ObservationRelationshipType (required)
.... target 1..1Reference(eHealth Observation | eHealth QuestionnaireResponse | Sequence)Resource that is related to this one
... component ΣI0..*BackboneElementComponent results
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINC Codes (example)
.... value[x] Σ0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual component result
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*Measurements and simple assertions made about a patient, device or other subject.
... extension 0..*ExtensionSlice: Unordered, Open by value:url
... ehealth-quality 0..*(Complex)Minimum requirements for qualities
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... ehealth-sharingPolicy 1..1CodingExtension
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-sharingPolicy
Binding: SubmissionSharingPolicies (required)
... basedOn 1..1Reference(eHealth ProcedureRequest)Fulfills procedure request.
... code 1..1CodeableConceptBinding: ObservationCodes (required)
... subject 1..1Reference(eHealth Patient)
... context 1..1Reference(eHealth EpisodeOfCare)
... effective[x] 1..1dateTime, Period
... performer 1..1Reference(eHealth Practitioner | eHealth Organization | eHealth Patient | eHealth RelatedPerson)
... value[x] 0..1Quantity, CodeableConcept
... device 1..1Reference(eHealth Device)
... referenceRange 0..*BackboneElement
.... low 0..1SimpleQuantity
.... high 0..1SimpleQuantity

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*Measurements and simple assertions made about a patient, device or other subject.
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ehealth-quality 0..*(Complex)Extension
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... ehealth-sharingPolicy 1..1CodingExtension
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-sharingPolicy
Binding: SubmissionSharingPolicies (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ1..1Reference(eHealth ProcedureRequest)Fulfills procedure request.
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category 0..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
... code Σ1..1CodeableConceptType of observation (code / type)
Binding: ObservationCodes (required)
... subject Σ1..1Reference(eHealth Patient)Who and/or what this is about
... context 1..1Reference(eHealth EpisodeOfCare)Healthcare event during which this observation is made
... effective[x] Σ1..1dateTime, PeriodClinically relevant time/time-period for observation
... issued Σ0..1instantDate/Time this was made available
... performer Σ1..1Reference(eHealth Practitioner | eHealth Organization | eHealth Patient | eHealth RelatedPerson)Who is responsible for the observation
... value[x] ΣI0..1Quantity, CodeableConceptActual result
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method 0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 1..1Reference(eHealth Device)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... related ΣI0..*BackboneElementResource related to this observation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 0..1codehas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
Binding: ObservationRelationshipType (required)
.... target 1..1Reference(eHealth Observation | eHealth QuestionnaireResponse | Sequence)Resource that is related to this one
... component ΣI0..*BackboneElementComponent results
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINC Codes (example)
.... value[x] Σ0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual component result
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

 

Terminology Bindings

PathNameConformanceValueSet
Observation.languageCommon LanguagesextensibleCommon Languages
Observation.statusObservationStatusrequiredObservationStatus
Observation.categoryObservation Category CodespreferredObservation Category Codes
Observation.codeObservationCodesrequiredObservationCodes
Observation.dataAbsentReasonObservation Value Absent ReasonextensibleObservation Value Absent Reason
Observation.interpretationObservation Interpretation CodesextensibleObservation Interpretation Codes
Observation.bodySiteSNOMED CT Body StructuresexampleSNOMED CT Body Structures
Observation.methodObservation MethodsexampleObservation Methods
Observation.referenceRange.typeObservation Reference Range Meaning CodesextensibleObservation Reference Range Meaning Codes
Observation.referenceRange.appliesToObservation Reference Range Applies To CodesexampleObservation Reference Range Applies To Codes
Observation.related.typeObservationRelationshipTyperequiredObservationRelationshipType
Observation.component.codeLOINC CodesexampleLOINC Codes
Observation.component.dataAbsentReasonObservation Value Absent ReasonextensibleObservation Value Absent Reason
Observation.component.interpretationObservation Interpretation CodesextensibleObservation Interpretation Codes

Constraints

IdPathDetailsRequirements
dom-2ObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-1ObservationIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.empty()
dom-4ObservationIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-3ObservationIf 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()
obs-7ObservationIf code is the same as a component code then the value element associated with the code SHALL NOT be present
: value.empty() or code!=component.code
obs-6ObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
ele-1Observation.referenceRangeAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
obs-3Observation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
ele-1Observation.relatedAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Observation.componentAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
.