MedComCoreObservation - Danish MedCom Core v2.3.0

This page is part of the DK MedCom Core (v2.3.0: Release) based on FHIR R4. The current version which supercedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: MedComCoreObservation

Official URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-core-observation				Version: 2.3.0
Active as of 2023-10-31				Computable Name: MedComCoreObservation

Observation profile intended to be used in MedComHomeCareObservation and MedCom’s Laboratory standards.

Note: This profile is developed to be part of a production trial of the communication between the general practitioner and municipal acute care team.

Scope and use

This profile is a MedCom Core profile for observations and is intended to represent observations for a variety cases including:

laboratory observations
observations performed by a municipal acute care team

Status

The MedComCoreObservation resource require an indication of the observation status. To indicate the observation status a code from ValueSet defined by MedCom shall be used. Click here se the status codes.

Codes

In a Observation resource, codes from CodeSystems are used to describe what is observed in the elements Observation.code.coding. In the element Observation.code.coding six CodeSystem are specified.

NPU codes are the most used codes in Danmark to express analysis performed at the laboratory.
LOINC codes is an international Codsystem for health measurements, observations, and documents. LOINC codes are less stricted then NPU codes.
IEEE codes are internationaly codes for devices and can be used to express an original observation from a device.
SKS codes are classifications for use in documenting patients and healthcare services.SKS have a few observation codes in use, most are found in the ‘R’ Hierarchy - see e.g. https://medinfo.dk/sks/brows.php.
MedCom codes are Danish codes, that have been necessary in Danish interoperability projects through time and are used to express analysis performed at the laboratory.
SNOMED CT codes are the world’s most comprehensive clinical terminology.SNOMED CT is often used as a reference terminology, to give a common language of retrieval for data that have originally been defined or coded in some other way

Usage:

Refer to this Resource Profile: MedComCoreDiagnosticReport

Formal Views of Profile Content

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

This structure is derived from DkCoreObservation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	DkCoreObservation	Measurements and simple assertions
status	S	1..1	code	registered \| partial \| preliminary \| final \| corrected \| cancelled \| entered-in-error Binding: MedComCoreObservationStatus (required)
code	S	1..1	CodeableConcept	Type of observation (code / type)
coding		0..*	Coding	Code defined by a terminology system
system	S	0..1	uri	Identity of the terminology system
code	S	0..1	code	Symbol in syntax defined by the system
coding:LOINC		0..1	Coding	LOINC code for the observation
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
coding:SNOMEDCT		0..1	Coding	SNOMED CT code for the observation
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
coding:NPU		0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
coding:IEEE		0..1	Coding	IEEE code for the observation
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
coding:MedCom		0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
coding:SKS		0..1	Coding	SKS code for the observation
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
subject	S	1..1	Reference(MedComCorePatient) {b }	Who and/or what the observation is about
Slices for effective[x]		0..1	dateTime, Period, Timing, instant	Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effective[x]:effectiveDateTime	S	0..1	dateTime	The date and time the sample was taken (Danish: prøvetegningstidspunkt).
note	S	0..*	Annotation	A comment on the individual result (Danish: Analysekommentar)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.status	required	MedComCoreObservationStatus

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	DkCoreObservation	Measurements and simple assertions
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered \| partial \| preliminary \| final \| corrected \| cancelled \| entered-in-error Binding: MedComCoreObservationStatus (required)
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
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	SΣ	0..1	uri	Identity of the terminology system
code	SΣ	0..1	code	Symbol in syntax defined by the system
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	SΣ	1..1	code	Symbol in syntax defined by the system
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: https://www.snomed.org/
code	SΣ	1..1	code	Symbol in syntax defined by the system
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.1
code	SΣ	1..1	code	Symbol in syntax defined by the system
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
code	SΣ	1..1	code	Symbol in syntax defined by the system
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: https://terminology.medcom.dk/fhir/observation-code
code	SΣ	1..1	code	Symbol in syntax defined by the system
coding:SKS	Σ	0..1	Coding	SKS code for the observation
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
code	SΣ	1..1	code	Symbol in syntax defined by the system
subject	SΣ	1..1	Reference(MedComCorePatient) {b }	Who and/or what the observation is about
Slices for effective[x]	Σ	0..1		Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
effective[x]:effectiveDateTime	SΣ	0..1	dateTime	The date and time the sample was taken (Danish: prøvetegningstidspunkt).
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
note	S	0..*	Annotation	A comment on the individual result (Danish: Analysekommentar)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Observation.status	required	MedComCoreObservationStatus
Observation.code	example	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator

Constraints

Id	Grade	Path(s)	Details	Requirements
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified : Observation.valueQuantity.value.exists() implies Observation.valueQuantity.unit.exists() or Observation.valueQuantity.code.exists()
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 or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.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 Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()