eHealth Infrastructure
3.4.1 - release Denmark flag

This page is part of the FUT Infrastructure (v3.4.1: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: ehealth-observation

Official URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-observation Version: 3.4.1
Active as of 2025-03-06 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.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Measurements and simple assertions
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: 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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... extension:episodeOfCare 1..1 Reference(EpisodeOfCare) Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... extension:quality 0..* (Complex) Minimum requirements for qualities
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... extension:resolvedTiming 1..1 (Complex) Resolved Timing
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.


ele-1: All FHIR elements must have a @value or children
... code Σ 1..1 CodeableConcept Type of observation (code / type)
Binding: Observation Codes (required)
ele-1: All FHIR elements must have a @value or children
... subject Σ 1..1 Reference(ehealth-patient) {r} Who and/or what the observation is about
ele-1: All FHIR elements must have a @value or children
... effective[x] Σ 1..1 Clinically relevant time/time-period for observation
ele-1: All FHIR elements must have a @value or children
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... performer Σ 1..1 Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r} Who is responsible for the observation
ele-1: All FHIR elements must have a @value or children
... value[x] ΣC 0..1 Actual result
ele-1: All FHIR elements must have a @value or children
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: Data Absent Reason (required)
ele-1: All FHIR elements must have a @value or children
... device 0..1 Reference(ehealth-device) {r} (Measurement) Device
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
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

 

Other representations of profile: CSV, Excel, Schematron