Scope and use

This profile is a MedCom Core profile for observation measurements and simple assertions made about a patient.

It is intended to represent observations for a variety cases including for example:

• laboratory observations
• observations performed by a municipal acute care team
• EKG study data

Status

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

Codes

In an 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 possible 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

Use of the valueAttachment Extension

This profile contains a FHIR extension designed to hold an attachment encoded in Base64. The valueAttachment element is implemented as an extension because the base value[x] element does not support the Attachment type. The extension can also capture essential metadata for the attachment.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	DkCoreObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact Obligations Actor SHALL:in-narrative Producer of FHIR resources
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment		0..*	Attachment	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SOΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) Obligations Actor SHALL:in-narrative Producer of FHIR resources
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:LOINC	Σ	0..1	Coding	LOINC code for the observation
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
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
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
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
code	Σ	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	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:SKS	Σ	0..1	Coding	SKS code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
code	Σ	1..1	code	Symbol in syntax defined by the system
subject	SOΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]	Σ	0..1		The date and time of the observation.
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
performer	SOΣ	1..*	Reference(MedComCoreOrganization | MedComCorePractitioner | MedComCorePractitionerRole | MedComCoreCareTeam | MedComCorePatient | Danish Core Related Person Profile)	Who is responsible for the observation Obligations Actor SHALL:in-narrative Producer of FHIR resources
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.
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 From the FHIR Standard

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 : value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).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()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

This structure is derived from DkCoreObservation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	DkCoreObservation	Measurements and simple assertions
id	SO	1..1	id	Logical id of this artifact Obligations Actor SHALL:in-narrative Producer of FHIR resources
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle.
status	S	1..1	code	generated | extensions | additional | empty
div	S	1..1	xhtml	Limited xhtml content
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment		0..*	Attachment	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
status	SO	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) Obligations Actor SHALL:in-narrative Producer of FHIR resources
code	S	1..1	CodeableConcept	Type of observation (code / type)
subject	SO	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]		0..1	dateTime, Period, Timing, instant	The date and time of the observation.
performer	SO	1..*	Reference(MedComCoreOrganization | MedComCorePractitioner | MedComCorePractitionerRole | MedComCoreCareTeam | MedComCorePatient | Danish Core Related Person Profile)	Who is responsible for the observation Obligations Actor SHALL:in-narrative Producer of FHIR resources
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	DkCoreObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact Obligations Actor SHALL:in-narrative Producer of FHIR resources
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment		0..*	Attachment	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SOΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) Obligations Actor SHALL:in-narrative Producer of FHIR resources
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
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:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
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
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	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
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://snomed.info/sct
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
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://npu-terminology.org
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
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: urn:iso:std:iso:11073:10101
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
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://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation
id		0..1	string	Unique id for inter-element referencing
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: urn:oid:1.2.208.176.2.4
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	0..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
subject	SOΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about Obligations Actor SHALL:in-narrative Producer of FHIR resources
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	Σ	0..1		The date and time of the observation.
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SOΣ	1..*	Reference(MedComCoreOrganization | MedComCorePractitioner | MedComCorePractitionerRole | MedComCoreCareTeam | MedComCorePatient | Danish Core Related Person Profile)	Who is responsible for the observation Obligations Actor SHALL:in-narrative Producer of FHIR resources
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
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..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	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
id		0..1	string	Unique id for inter-element referencing
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:SCTCode	Σ	0..1	Coding	Code defined by a terminology system Binding: DK TechniquesSCTCodes (example)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct|http://snomed.info/sct/554471000005108
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..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(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	The device used for the measurement. It is recommended that when information about the device is sent, it is contained in the same Bundle as the Observation the device measured.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant
high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (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
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
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:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
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
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	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
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://snomed.info/sct
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
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://npu-terminology.org
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
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: urn:iso:std:iso:11073:10101
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
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://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation.
id		0..1	string	Unique id for inter-element referencing
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: urn:oid:1.2.208.176.2.4
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	0..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
Slices for value[x]	Σ	0..1		Actual component 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	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..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	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (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	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category|4.0.1 From the FHIR Standard
Observation.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 From the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1 From the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1 From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site|4.0.1 From the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods|4.0.1 From the FHIR Standard
Observation.method.coding:SCTCode	example	TechniquesSCTCodes http://hl7.dk/fhir/core/ValueSet/dk-core-TechniquesSCTCodes
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning|4.0.1 From the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto|4.0.1 From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 From the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1 From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1 From the FHIR Standard

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 : value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).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-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 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()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	DkCoreObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact Obligations Actor SHALL:in-narrative Producer of FHIR resources
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment		0..*	Attachment	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SOΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) Obligations Actor SHALL:in-narrative Producer of FHIR resources
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:LOINC	Σ	0..1	Coding	LOINC code for the observation
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
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
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
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
code	Σ	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	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:SKS	Σ	0..1	Coding	SKS code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
code	Σ	1..1	code	Symbol in syntax defined by the system
subject	SOΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]	Σ	0..1		The date and time of the observation.
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
performer	SOΣ	1..*	Reference(MedComCoreOrganization | MedComCorePractitioner | MedComCorePractitionerRole | MedComCoreCareTeam | MedComCorePatient | Danish Core Related Person Profile)	Who is responsible for the observation Obligations Actor SHALL:in-narrative Producer of FHIR resources
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.
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 From the FHIR Standard

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 : value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).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()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

Differential View

This structure is derived from DkCoreObservation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	DkCoreObservation	Measurements and simple assertions
id	SO	1..1	id	Logical id of this artifact Obligations Actor SHALL:in-narrative Producer of FHIR resources
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle.
status	S	1..1	code	generated | extensions | additional | empty
div	S	1..1	xhtml	Limited xhtml content
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment		0..*	Attachment	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
status	SO	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) Obligations Actor SHALL:in-narrative Producer of FHIR resources
code	S	1..1	CodeableConcept	Type of observation (code / type)
subject	SO	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]		0..1	dateTime, Period, Timing, instant	The date and time of the observation.
performer	SO	1..*	Reference(MedComCoreOrganization | MedComCorePractitioner | MedComCorePractitionerRole | MedComCoreCareTeam | MedComCorePatient | Danish Core Related Person Profile)	Who is responsible for the observation Obligations Actor SHALL:in-narrative Producer of FHIR resources
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	DkCoreObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact Obligations Actor SHALL:in-narrative Producer of FHIR resources
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment		0..*	Attachment	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SOΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) Obligations Actor SHALL:in-narrative Producer of FHIR resources
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
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:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
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
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	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
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://snomed.info/sct
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
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://npu-terminology.org
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
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: urn:iso:std:iso:11073:10101
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
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://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation
id		0..1	string	Unique id for inter-element referencing
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: urn:oid:1.2.208.176.2.4
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	0..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
subject	SOΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about Obligations Actor SHALL:in-narrative Producer of FHIR resources
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	Σ	0..1		The date and time of the observation.
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SOΣ	1..*	Reference(MedComCoreOrganization | MedComCorePractitioner | MedComCorePractitionerRole | MedComCoreCareTeam | MedComCorePatient | Danish Core Related Person Profile)	Who is responsible for the observation Obligations Actor SHALL:in-narrative Producer of FHIR resources
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
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..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	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
id		0..1	string	Unique id for inter-element referencing
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:SCTCode	Σ	0..1	Coding	Code defined by a terminology system Binding: DK TechniquesSCTCodes (example)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct|http://snomed.info/sct/554471000005108
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..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(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	The device used for the measurement. It is recommended that when information about the device is sent, it is contained in the same Bundle as the Observation the device measured.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant
high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (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
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
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:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
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
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	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
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://snomed.info/sct
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
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://npu-terminology.org
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
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: urn:iso:std:iso:11073:10101
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
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://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
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	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation.
id		0..1	string	Unique id for inter-element referencing
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: urn:oid:1.2.208.176.2.4
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	0..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
Slices for value[x]	Σ	0..1		Actual component 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	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..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	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (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	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category|4.0.1 From the FHIR Standard
Observation.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 From the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1 From the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1 From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site|4.0.1 From the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods|4.0.1 From the FHIR Standard
Observation.method.coding:SCTCode	example	TechniquesSCTCodes http://hl7.dk/fhir/core/ValueSet/dk-core-TechniquesSCTCodes
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning|4.0.1 From the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto|4.0.1 From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 From the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1 From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1 From the FHIR Standard

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 : value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).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-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 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()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

This structure is derived from DkCoreObservation

Summary

Mandatory: 3 elements
Must-Support: 8 elements

Structures

This structure refers to these other structures:

• MedComCorePatient (http://medcomfhir.dk/ig/core/StructureDefinition/medcom-core-patient)
• MedComCoreOrganization (http://medcomfhir.dk/ig/core/StructureDefinition/medcom-core-organization)
• MedComCorePractitioner (http://medcomfhir.dk/ig/core/StructureDefinition/medcom-core-practitioner)
• MedComCorePractitionerRole (http://medcomfhir.dk/ig/core/StructureDefinition/medcom-core-practitionerrole)
• MedComCoreCareTeam (http://medcomfhir.dk/ig/core/StructureDefinition/medcom-core-careteam)
• Danish Core Related Person Profile (http://hl7.dk/fhir/core/StructureDefinition/dk-core-related-person)

Extensions

This structure refers to these extensions:

• http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension