eHealth Infrastructure
2.5.0 - release

eHealth Infrastructure - Local Development build (v2.5.0). See the Directory of published versions

Resource Profile: ehealth-observation

Official URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-observation Version: 2.5.0
Active as of 2023-02-09 Computable Name: ehealth-observation

Introduction

An Observation contains the result of a measurement performed by the Patient. It is based on a ServiceRequest 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 ServiceRequest. 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. See the profile ehealth-communication for further details.
  • 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
  • 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.

Usage:

  • Refer to this Resource Profile:

Formal Views of Profile Content

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

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*ObservationMeasurements and simple assertions
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... quality 0..*(Complex)Minimum requirements for qualities
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... basedOn 1..1Reference(ehealth-servicerequest) {r}Fulfills plan, proposal or order
... code 1..1CodeableConceptType of observation (code / type)
Binding: Observation Codes (required)
... subject 1..1Reference(ehealth-patient) {r}Who and/or what the observation is about
... effective[x] 1..1dateTime, Period, Timing, instantClinically relevant time/time-period for observation
... performer 1..1Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}Who is responsible for the observation
... value[x] 0..1Actual result
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
... device 0..1Reference(ehealth-device) {r}(Measurement) Device
... referenceRange
.... type 0..1CodeableConceptReference range qualifier
Binding: Reference Range Type (required)
... component
.... code 1..1CodeableConceptType of component observation (code / type)
Binding: Observation Codes (required)
.... value[x] 0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Observation.coderequiredObservationCodes
Observation.referenceRange.typerequiredReferenceRangeType
Observation.component.coderequiredObservationCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... resolvedTiming 1..1(Complex)Resolved Timing
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... basedOn Σ1..1Reference(ehealth-servicerequest) {r}Fulfills plan, proposal or order
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... code Σ1..1CodeableConceptType of observation (code / type)
Binding: Observation Codes (required)
... subject Σ1..1Reference(ehealth-patient) {r}Who and/or what the observation is about
... effective[x] Σ1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... performer Σ1..1Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}Who is responsible for the observation
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
... device 0..1Reference(ehealth-device) {r}(Measurement) Device

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.statusrequiredObservationStatus
Observation.coderequiredObservationCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... 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: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... quality 0..*(Complex)Minimum requirements for qualities
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... resolvedTiming 1..1(Complex)Resolved Timing
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ1..1Reference(ehealth-servicerequest) {r}Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... category 0..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


... code Σ1..1CodeableConceptType of observation (code / type)
Binding: Observation Codes (required)
... subject Σ1..1Reference(ehealth-patient) {r}Who and/or what the observation is about
... focus Σ0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] Σ1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued Σ0..1instantDate/Time this version was made available
... performer Σ1..1Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}Who is responsible for the observation
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
... dataAbsentReason C0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(ehealth-device) {r}(Measurement) Device
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Reference Range Type (required)
.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component Σ0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: Observation Codes (required)
.... value[x] Σ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
.... dataAbsentReason C0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.coderequiredObservationCodes
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typerequiredReferenceRangeType
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.coderequiredObservationCodes
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*ObservationMeasurements and simple assertions
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... quality 0..*(Complex)Minimum requirements for qualities
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... basedOn 1..1Reference(ehealth-servicerequest) {r}Fulfills plan, proposal or order
... code 1..1CodeableConceptType of observation (code / type)
Binding: Observation Codes (required)
... subject 1..1Reference(ehealth-patient) {r}Who and/or what the observation is about
... effective[x] 1..1dateTime, Period, Timing, instantClinically relevant time/time-period for observation
... performer 1..1Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}Who is responsible for the observation
... value[x] 0..1Actual result
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
... device 0..1Reference(ehealth-device) {r}(Measurement) Device
... referenceRange
.... type 0..1CodeableConceptReference range qualifier
Binding: Reference Range Type (required)
... component
.... code 1..1CodeableConceptType of component observation (code / type)
Binding: Observation Codes (required)
.... value[x] 0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Observation.coderequiredObservationCodes
Observation.referenceRange.typerequiredReferenceRangeType
Observation.component.coderequiredObservationCodes

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... resolvedTiming 1..1(Complex)Resolved Timing
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... basedOn Σ1..1Reference(ehealth-servicerequest) {r}Fulfills plan, proposal or order
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... code Σ1..1CodeableConceptType of observation (code / type)
Binding: Observation Codes (required)
... subject Σ1..1Reference(ehealth-patient) {r}Who and/or what the observation is about
... effective[x] Σ1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... performer Σ1..1Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}Who is responsible for the observation
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
... device 0..1Reference(ehealth-device) {r}(Measurement) Device

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.statusrequiredObservationStatus
Observation.coderequiredObservationCodes

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*ObservationMeasurements and simple assertions
... 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: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... quality 0..*(Complex)Minimum requirements for qualities
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
... resolvedTiming 1..1(Complex)Resolved Timing
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ1..1Reference(ehealth-servicerequest) {r}Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... category 0..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


... code Σ1..1CodeableConceptType of observation (code / type)
Binding: Observation Codes (required)
... subject Σ1..1Reference(ehealth-patient) {r}Who and/or what the observation is about
... focus Σ0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] Σ1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued Σ0..1instantDate/Time this version was made available
... performer Σ1..1Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}Who is responsible for the observation
... value[x] ΣC0..1Actual result
.... valueQuantityQuantity
.... valueCodeableConceptCodeableConcept
... dataAbsentReason C0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(ehealth-device) {r}(Measurement) Device
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Reference Range Type (required)
.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component Σ0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: Observation Codes (required)
.... value[x] Σ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
.... dataAbsentReason C0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.coderequiredObservationCodes
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typerequiredReferenceRangeType
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.coderequiredObservationCodes
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

 

Other representations of profile: CSV, Excel, Schematron