eHealth Infrastructure
3.0.0 - release

eHealth Infrastructure - Local Development build (v3.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: ehealth-observation

Official URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-observation Version: 3.0.0
Active as of 2024-05-16 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.

Marking Observations with result missing

An Observation is expected to contain a result along with details, for instance when it was obtained. In the event that no result can be measured or otherwise obtained, an Observation can be submitted with the .dataAbsentReason specified.

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:

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 Observation
... 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
... dataAbsentReason 0..1CodeableConceptWhy the result is missing
Binding: Data Absent Reason (required)
... 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)

PathConformanceValueSetURI
Observation.coderequiredObservationCodes
http://ehealth.sundhed.dk/vs/observation-codes
from this IG
Observation.dataAbsentReasonrequiredDataAbsentReason
http://ehealth.sundhed.dk/vs/data-absent-reason
from this IG
Observation.referenceRange.typerequiredReferenceRangeType
http://ehealth.sundhed.dk/vs/reference-range-type
from this IG
Observation.component.coderequiredObservationCodes
http://ehealth.sundhed.dk/vs/observation-codes
from this IG

 

Other representations of profile: CSV, Excel, Schematron