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.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	Measurements and simple assertions Constraints: obs-6, obs-7
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:episodeOfCare		1..1	(Complex)	Associated Encounter episode of care URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare"
value[x]		1..1	Reference(ehealth-episodeofcare) {r}	Value of extension
extension:quality		0..*	(Complex)	Minimum requirements for qualities URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
extension:resolvedTiming		1..1	(Complex)	Resolved Timing URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	1..1	Reference(ehealth-servicerequest) {r}	Fulfills plan, proposal or order
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
code	Σ	1..1	CodeableConcept	Type of observation (code / type) Binding: Observation Codes (required)
subject	Σ	1..1	Reference(ehealth-patient) {r}	Who and/or what the observation is about
effective[x]	Σ	1..1		Clinically relevant time/time-period for observation
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
value[x]	ΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: Data Absent Reason (required)
device		0..1	Reference(ehealth-device) {r}	(Measurement) Device
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.dataAbsentReason	required	DataAbsentReason http://ehealth.sundhed.dk/vs/data-absent-reason From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation			Observation
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:episodeOfCare		1..1	(Complex)	Associated Encounter episode of care URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
value[x]		1..1	Reference(ehealth-episodeofcare) {r}	Value of extension
extension:quality		0..*	(Complex)	Minimum requirements for qualities URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
extension:resolvedTiming		1..1	(Complex)	Resolved Timing URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
basedOn		1..1	Reference(ehealth-servicerequest) {r}	Fulfills plan, proposal or order
code		1..1	CodeableConcept	Type of observation (code / type) Binding: Observation Codes (required)
subject		1..1	Reference(ehealth-patient) {r}	Who and/or what the observation is about
effective[x]		1..1	dateTime, Period, Timing, instant	Clinically relevant time/time-period for observation
performer		1..1	Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}	Who is responsible for the observation
value[x]		0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
dataAbsentReason		0..1	CodeableConcept	Why the result is missing Binding: Data Absent Reason (required)
device		0..1	Reference(ehealth-device) {r}	(Measurement) Device
referenceRange
type		0..1	CodeableConcept	Reference range qualifier Binding: Reference Range Type (required)
component
code		1..1	CodeableConcept	Type of component observation (code / type) Binding: Observation Codes (required)
value[x]		0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.dataAbsentReason	required	DataAbsentReason http://ehealth.sundhed.dk/vs/data-absent-reason From this IG
Observation.referenceRange.type	required	ReferenceRangeType http://ehealth.sundhed.dk/vs/reference-range-type From this IG
Observation.component.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	Measurements and simple assertions Constraints: obs-6, obs-7
id	Σ	0..1	id	Logical id of this artifact
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		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:episodeOfCare		1..1	(Complex)	Associated Encounter episode of care URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare"
value[x]		1..1	Reference(ehealth-episodeofcare) {r}	Value of extension
extension:quality		0..*	(Complex)	Minimum requirements for qualities URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
extension:resolvedTiming		1..1	(Complex)	Resolved Timing URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	1..1	Reference(ehealth-servicerequest) {r}	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	Σ	1..1	CodeableConcept	Type of observation (code / type) Binding: Observation Codes (required)
subject	Σ	1..1	Reference(ehealth-patient) {r}	Who and/or what the observation is about
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	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	1..1	Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}	Who is responsible for the observation
value[x]	ΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: Data Absent Reason (required)
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.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(ehealth-device) {r}	(Measurement) Device
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	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: Reference Range Type (required)
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: Observation Codes (required)
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
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 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.dataAbsentReason	required	DataAbsentReason http://ehealth.sundhed.dk/vs/data-absent-reason From this IG
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods From the FHIR Standard
Observation.referenceRange.type	required	ReferenceRangeType http://ehealth.sundhed.dk/vs/reference-range-type From this IG
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto From the FHIR Standard
Observation.component.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	Measurements and simple assertions Constraints: obs-6, obs-7
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:episodeOfCare		1..1	(Complex)	Associated Encounter episode of care URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare"
value[x]		1..1	Reference(ehealth-episodeofcare) {r}	Value of extension
extension:quality		0..*	(Complex)	Minimum requirements for qualities URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
extension:resolvedTiming		1..1	(Complex)	Resolved Timing URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	1..1	Reference(ehealth-servicerequest) {r}	Fulfills plan, proposal or order
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
code	Σ	1..1	CodeableConcept	Type of observation (code / type) Binding: Observation Codes (required)
subject	Σ	1..1	Reference(ehealth-patient) {r}	Who and/or what the observation is about
effective[x]	Σ	1..1		Clinically relevant time/time-period for observation
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
value[x]	ΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: Data Absent Reason (required)
device		0..1	Reference(ehealth-device) {r}	(Measurement) Device
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.dataAbsentReason	required	DataAbsentReason http://ehealth.sundhed.dk/vs/data-absent-reason From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation			Observation
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:episodeOfCare		1..1	(Complex)	Associated Encounter episode of care URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
value[x]		1..1	Reference(ehealth-episodeofcare) {r}	Value of extension
extension:quality		0..*	(Complex)	Minimum requirements for qualities URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
extension:resolvedTiming		1..1	(Complex)	Resolved Timing URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
basedOn		1..1	Reference(ehealth-servicerequest) {r}	Fulfills plan, proposal or order
code		1..1	CodeableConcept	Type of observation (code / type) Binding: Observation Codes (required)
subject		1..1	Reference(ehealth-patient) {r}	Who and/or what the observation is about
effective[x]		1..1	dateTime, Period, Timing, instant	Clinically relevant time/time-period for observation
performer		1..1	Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}	Who is responsible for the observation
value[x]		0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
dataAbsentReason		0..1	CodeableConcept	Why the result is missing Binding: Data Absent Reason (required)
device		0..1	Reference(ehealth-device) {r}	(Measurement) Device
referenceRange
type		0..1	CodeableConcept	Reference range qualifier Binding: Reference Range Type (required)
component
code		1..1	CodeableConcept	Type of component observation (code / type) Binding: Observation Codes (required)
value[x]		0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.dataAbsentReason	required	DataAbsentReason http://ehealth.sundhed.dk/vs/data-absent-reason From this IG
Observation.referenceRange.type	required	ReferenceRangeType http://ehealth.sundhed.dk/vs/reference-range-type From this IG
Observation.component.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	Measurements and simple assertions Constraints: obs-6, obs-7
id	Σ	0..1	id	Logical id of this artifact
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		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:episodeOfCare		1..1	(Complex)	Associated Encounter episode of care URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare"
value[x]		1..1	Reference(ehealth-episodeofcare) {r}	Value of extension
extension:quality		0..*	(Complex)	Minimum requirements for qualities URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
extension:resolvedTiming		1..1	(Complex)	Resolved Timing URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	1..1	Reference(ehealth-servicerequest) {r}	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	Σ	1..1	CodeableConcept	Type of observation (code / type) Binding: Observation Codes (required)
subject	Σ	1..1	Reference(ehealth-patient) {r}	Who and/or what the observation is about
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	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	1..1	Reference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-relatedperson) {r}	Who is responsible for the observation
value[x]	ΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: Data Absent Reason (required)
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.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(ehealth-device) {r}	(Measurement) Device
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	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: Reference Range Type (required)
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: Observation Codes (required)
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
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 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.dataAbsentReason	required	DataAbsentReason http://ehealth.sundhed.dk/vs/data-absent-reason From this IG
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods From the FHIR Standard
Observation.referenceRange.type	required	ReferenceRangeType http://ehealth.sundhed.dk/vs/reference-range-type From this IG
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto From the FHIR Standard
Observation.component.code	required	ObservationCodes http://ehealth.sundhed.dk/vs/observation-codes From this IG
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

This structure is derived from Observation

Summary

Mandatory: 6 elements

Structures

This structure refers to these other structures:

• ehealth-episodeofcare (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-episodeofcare)
• ehealth-servicerequest (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-servicerequest)
• ehealth-patient (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-patient)
• ehealth-practitioner (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-practitioner)
• ehealth-organization (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-organization)
• ehealth-relatedperson (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-relatedperson)
• ehealth-device (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-device)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-quality
• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-resolved-timing