This observation may represent the result of a simple laboratory test such as hematocrit or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and references the atomic results of the study as "has-member" child observations

Represents either a lab simple observation or the group of observations produced by a laboratory study.

• Observation Results: laboratory

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

R5: Observation.bodyStructure (new:Reference(BodyStructure))

Element Observation.bodyStructure has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.bodyStructure has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). Only used if not implicit in code found in Observation.code or bodySite is used. In many systems, this may be represented as a related observation instead of an inline component.

EHDSObservation.anatomicLocation

R5: Observation.triggeredBy (new:BackboneElement)

Element Observation.triggeredBy has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

An Extension

An Extension

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Reference to the triggering observation.

EHDSObservation.triggeredBy[x]

R5: Observation.triggeredBy.type (new:code)

Element Observation.triggeredBy.type is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.type has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.type has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Element Observation.triggeredBy.type is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.type has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.type has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

The type of trigger. Reflex | Repeat | Re-run.

The type of TriggeredBy Observation.

R5: Observation.triggeredBy.reason (new:string)

Element Observation.triggeredBy.reason is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.reason has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.reason has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Element Observation.triggeredBy.reason is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.reason has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.reason has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

When the result is a Diagram or Picture (Microbiology), then the Attachment data type should be used. In FHIR R4 this can be done by preadopting the R5 Observation.value[x] element using the cross-version extension.

Element Observation.value[x] is mapped to FHIR R4 element Observation.value[x] as SourceIsBroaderThanTarget. The mappings for Observation.value[x] do not cover the following types: Attachment, Reference. The target context Observation.value[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Observation.

• An observation may have:
  1. a single value here
  2. both a value and a set of related or component values
  3. only a set of related or component values.
• If a value is present, the datatype for this element should be determined by the code.
• CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the code defines a coded value.
• Attachment is used if the observation result value is a binary file such as an image. If the observation result value is derived from the binary file (for example 'X' detected and here is the the proof in this image), the binary file may be directly represented using DocumentReference and referenced by derivedFrom.
• The usage of valueReference is restricted to the MolecularSequence resource when used as a definitional resource, not as a patient-specific finding. .
• For additional guidance, see the Notes section below.

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Other resources from the patient record that may be relevant to the event. The information from these resources was either used to create the instance or is provided to help with its interpretation. This extension should not be used if more specific inline elements or extensions are available. For example, use Observation.hasMember instead of supportingInformation for representing the members of an Observation panel.

The laboratory test kit used for this test.

This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using a CodeableConcept. This extension should be used when the unit is UCUM [IU].

This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using an Identifier. This extension should be used when the unit is UCUM [IU].

Indicates that this laboratory test was/is accredited.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

EHDSObservation.order

The status of the result value.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Codes providing the status of an observation.

EHDSObservation.header.status

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

Describes what was observed. Sometimes this is called the observation "name".

All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

EHDSObservation.code

The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

EHDSObservation.header.subject

The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

EHDSObservation.directSubject[x]

The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.

At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

EHDSObservation.observationDate[x]

Who was responsible for asserting the observed value as "true".

EHDSObservation.header.performer

Distinguishes the type of involvement of the performer in the event. For example, 'author', 'verifier' or 'responsible party'.

EHDSObservation.performer.function

The information determined as a result of making the observation, if the information has a simple value.

An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

EHDSObservation.result.value[x]

The information determined as a result of making the observation, if the information has a simple value.

An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

EHDSObservation.result.value[x]

The information determined as a result of making the observation, if the information has a simple value.

An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

EHDSObservation.result.value[x]

The information determined as a result of making the observation, if the information has a simple value.

An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

The primary measure of variance/uncertainty of the value (the square root of the sum of the squares of the differences between all data points and the mean).

standardDeviation has the same units as the quantity. It is used to normalize the data for computing the distribution function. Applications that cannot deal with probability distributions can still get an idea about the confidence level by looking at standardDeviation.

EHDSObservation.result.uncertainty

How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

How the Quantity should be understood and represented.

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

The information determined as a result of making the observation, if the information has a simple value.

An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

EHDSObservation.result.value[x]

Indicates the mechanism used to perform the observation.

Only used if not implicit in code for Observation.code.

EHDSObservation.method

The specimen that was used when this observation was made.

Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

The device used to generate the observation data.

Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

Device information for laboratory observations

This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.

When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

EHDSObservation.hasMember[x]

Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

For a discussion on the ways Observations can be assembled in groups together see Notes below.

EHDSObservation.component

When the result is a Diagram or Picture (Microbiology), then the Attachment data type should be used. In FHIR R4 this can be done by preadopting the R5 Observation.value[x] element using the cross-version extension.

Element Observation.value[x] is mapped to FHIR R4 element Observation.value[x] as SourceIsBroaderThanTarget. The mappings for Observation.value[x] do not cover the following types: Attachment, Reference. The target context Observation.value[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Observation.

• An observation may have:
  1. a single value here
  2. both a value and a set of related or component values
  3. only a set of related or component values.
• If a value is present, the datatype for this element should be determined by the code.
• CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the code defines a coded value.
• Attachment is used if the observation result value is a binary file such as an image. If the observation result value is derived from the binary file (for example 'X' detected and here is the the proof in this image), the binary file may be directly represented using DocumentReference and referenced by derivedFrom.
• The usage of valueReference is restricted to the MolecularSequence resource when used as a definitional resource, not as a patient-specific finding. .
• For additional guidance, see the Notes section below.

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Describes what was observed. Sometimes this is called the observation "code".

All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

EHDSObservation.component.code

The information determined as a result of making the observation, if the information has a simple value.

Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

EHDSObservation.component.result.value[x]

The information determined as a result of making the observation, if the information has a simple value.

Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

EHDSObservation.component.result.value[x]

The information determined as a result of making the observation, if the information has a simple value.

Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

The primary measure of variance/uncertainty of the value (the square root of the sum of the squares of the differences between all data points and the mean).

standardDeviation has the same units as the quantity. It is used to normalize the data for computing the distribution function. Applications that cannot deal with probability distributions can still get an idea about the confidence level by looking at standardDeviation.

EHDSObservation.component.result.uncertainty

How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

How the Quantity should be understood and represented.

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

The information determined as a result of making the observation, if the information has a simple value.

Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

EHDSObservation.component.result.value[x]

This observation may represent the result of a simple laboratory test such as hematocrit or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and references the atomic results of the study as "has-member" child observations

Represents either a lab simple observation or the group of observations produced by a laboratory study.

• Observation Results: laboratory

The laboratory test kit used for this test.

Indicates that this laboratory test was/is accredited.

This observation may represent the result of a simple laboratory test such as hematocrit or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and references the atomic results of the study as "has-member" child observations

Represents either a lab simple observation or the group of observations produced by a laboratory study.

• Observation Results: laboratory

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

R5: Observation.bodyStructure (new:Reference(BodyStructure))

Element Observation.bodyStructure has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.bodyStructure has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). Only used if not implicit in code found in Observation.code or bodySite is used. In many systems, this may be represented as a related observation instead of an inline component.

EHDSObservation.anatomicLocation

R5: Observation.triggeredBy (new:BackboneElement)

Element Observation.triggeredBy has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

An Extension

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Reference to the triggering observation.

EHDSObservation.triggeredBy[x]

R5: Observation.triggeredBy.type (new:code)

Element Observation.triggeredBy.type is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.type has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.type has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Element Observation.triggeredBy.type is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.type has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.type has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

The type of trigger. Reflex | Repeat | Re-run.

The type of TriggeredBy Observation.

R5: Observation.triggeredBy.reason (new:string)

Element Observation.triggeredBy.reason is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.reason has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.reason has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Element Observation.triggeredBy.reason is part of an existing definition because parent element Observation.triggeredBy requires a cross-version extension. Element Observation.triggeredBy.reason has a context of Observation based on following the parent source element upwards and mapping to Observation. Element Observation.triggeredBy.reason has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Provides the reason why this observation was performed as a result of the observation(s) referenced.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

When the result is a Diagram or Picture (Microbiology), then the Attachment data type should be used. In FHIR R4 this can be done by preadopting the R5 Observation.value[x] element using the cross-version extension.

Element Observation.value[x] is mapped to FHIR R4 element Observation.value[x] as SourceIsBroaderThanTarget. The mappings for Observation.value[x] do not cover the following types: Attachment, Reference. The target context Observation.value[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Observation.

• An observation may have:
  1. a single value here
  2. both a value and a set of related or component values
  3. only a set of related or component values.
• If a value is present, the datatype for this element should be determined by the code.
• CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the code defines a coded value.
• Attachment is used if the observation result value is a binary file such as an image. If the observation result value is derived from the binary file (for example 'X' detected and here is the the proof in this image), the binary file may be directly represented using DocumentReference and referenced by derivedFrom.
• The usage of valueReference is restricted to the MolecularSequence resource when used as a definitional resource, not as a patient-specific finding. .
• For additional guidance, see the Notes section below.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

The information determined as a result of making the observation, if the information has a simple value.

• An observation may have:
  1. a single value here
  2. both a value and a set of related or component values
  3. only a set of related or component values.
• If a value is present, the datatype for this element should be determined by the code.
• CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the code defines a coded value.
• Attachment is used if the observation result value is a binary file such as an image. If the observation result value is derived from the binary file (for example 'X' detected and here is the the proof in this image), the binary file may be directly represented using DocumentReference and referenced by derivedFrom.
• The usage of valueReference is restricted to the MolecularSequence resource when used as a definitional resource, not as a patient-specific finding. .
• For additional guidance, see the Notes section below.

Other resources from the patient record that may be relevant to the event. The information from these resources was either used to create the instance or is provided to help with its interpretation. This extension should not be used if more specific inline elements or extensions are available. For example, use Observation.hasMember instead of supportingInformation for representing the members of an Observation panel.

The laboratory test kit used for this test.

This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using a CodeableConcept. This extension should be used when the unit is UCUM [IU].

This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using an Identifier. This extension should be used when the unit is UCUM [IU].

Indicates that this laboratory test was/is accredited.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

A unique identifier assigned to this observation.

EHDSObservation.header.identifier

A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

EHDSObservation.order

A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.

To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

The status of the result value.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Codes providing the status of an observation.

EHDSObservation.header.status

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Used for filtering what observations are retrieved and displayed.

Describes what was observed. Sometimes this is called the observation "name".

All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.