US Core Implementation Guide
6.1.0 - STU6 United States of America flag

This page is part of the US Core (v6.1.0: STU6 Update) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions. Page versions: STU6.1 STU6 STU5 STU4

Resource Profile: US Core Vital Signs Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs Version: 6.1.0
Active as of 2020-11-17 Computable Name: USCoreVitalSignsProfile

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

To promote interoperability and adoption through common implementation, this profile is based on the base FHIR Vital Signs Profile and defines additional constraints on the Observation resource to represent vital signs observations. It identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases. This US Core profiles that are derived from this profile are listed below.

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile-specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements. The “Snapshot Table (Must Support)” tab below displays all the Mandatory and Must Support data elements for this profile and those inherited from the US Core Vital Signs Profile.

Each Observation Must Have:

  1. a status
  2. a category code of “vital-signs”
  3. a LOINC code, if available, which tells you what is being measured
  4. a patient
  5. a clinically relevant time

Each Observation Must Support:

  1. a result value
    • if the result value is a numeric quantity, a standard UCUM unit
  2. a reason if the value is absent*
  3. component results

*see guidance below

Profile Specific Implementation Guidance:

  • The observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
    • providing a local system specific code
    • providing more specific codes such as 8306-3 - Body height - lying in addition to 8302-2 - Body height. Several additional observation codes are provided in the FHIR core specification vital signs table.

    a code system value SHOULD be supplied for each additional code.

  • The observations MAY have component observations. For example, to qualify the vital sign observation 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. Several of these are provided in the FHIR core specification vital signs table.
  • *An Observation without a value, SHALL include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using Observation.hasMember.
    • For further guidance see the Observation Grouping section in FHIR Specification.
    • Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason.
  • *An Observation.component without a value, SHALL include a reason why the data is absent.
    • Systems that never provide a component observation without a component value are not required to support Observation.component.dataAbsentReason.
  • Implementers may use this profile as a base for other vital signs in addition to those in this guide.

Usage:

Formal Views of Profile Content

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

This structure is derived from observation-vitalsigns

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*observation-vitalsignsUS Core Vital Signs Profile
... status S1..1code(USCDI) registered | preliminary | final | amended +
... Slices for category S1..*CodeableConcept(USCDI) Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
.... category:VSCat S1..1CodeableConcept(USCDI) Classification of type of observation
..... coding S1..*Coding(USCDI) Code defined by a terminology system
...... system S1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code S1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
... code S1..1CodeableConcept(USCDI) Coded Responses from C-CDA Vital Sign Results
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

... subject S1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... effective[x] S1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime S
.... effectivePeriodPeriod
... value[x] S0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity S
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason S0..1CodeableConcept(USCDI) Why the result is missing
... component S0..*BackboneElement(USCDI) Component observations
.... code S1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

.... value[x] S0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantityQuantity S
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason S0..1CodeableConcept(USCDI) Why the component result is missing

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Observation.codeextensibleUsCoreVitalSigns
Observation.value[x]extensibleVitalSignsUnits
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*observation-vitalsignsUS Core Vital Signs Profile
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ1..1CodeableConcept(USCDI) Coded Responses from C-CDA Vital Sign Results
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... component SΣC0..*BackboneElement(USCDI) Component observations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

.... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantityQuantity
.... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensibleUsCoreVitalSigns
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-2errorObservationIf there is no component or hasMember element then either a value[x] or a data absent reason must be present.
: (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*observation-vitalsignsUS Core Vital Signs Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
... code SΣ1..1CodeableConcept(USCDI) Coded Responses from C-CDA Vital Sign Results
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... focus ΣTU0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime S
.... effectivePeriodPeriod
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity S
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Used when reporting vital signs panel components
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Related measurements the observation is made from
... component SΣC0..*BackboneElement(USCDI) Component observations
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

.... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantityQuantity S
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensibleUsCoreVitalSigns
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-3errorObservation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

This structure is derived from observation-vitalsigns

Summary

Mandatory: 5 elements
Must-Support: 15 elements
Fixed Value: 2 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Observation.category is sliced based on the values of value:coding.code, value:coding.system

Differential View

This structure is derived from observation-vitalsigns

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*observation-vitalsignsUS Core Vital Signs Profile
... status S1..1code(USCDI) registered | preliminary | final | amended +
... Slices for category S1..*CodeableConcept(USCDI) Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
.... category:VSCat S1..1CodeableConcept(USCDI) Classification of type of observation
..... coding S1..*Coding(USCDI) Code defined by a terminology system
...... system S1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code S1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
... code S1..1CodeableConcept(USCDI) Coded Responses from C-CDA Vital Sign Results
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

... subject S1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... effective[x] S1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime S
.... effectivePeriodPeriod
... value[x] S0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity S
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason S0..1CodeableConcept(USCDI) Why the result is missing
... component S0..*BackboneElement(USCDI) Component observations
.... code S1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

.... value[x] S0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantityQuantity S
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason S0..1CodeableConcept(USCDI) Why the component result is missing

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Observation.codeextensibleUsCoreVitalSigns
Observation.value[x]extensibleVitalSignsUnits
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*observation-vitalsignsUS Core Vital Signs Profile
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ1..1CodeableConcept(USCDI) Coded Responses from C-CDA Vital Sign Results
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... component SΣC0..*BackboneElement(USCDI) Component observations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

.... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantityQuantity
.... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensibleUsCoreVitalSigns
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-2errorObservationIf there is no component or hasMember element then either a value[x] or a data absent reason must be present.
: (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*observation-vitalsignsUS Core Vital Signs Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:VSCat S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
... code SΣ1..1CodeableConcept(USCDI) Coded Responses from C-CDA Vital Sign Results
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... focus ΣTU0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime S
.... effectivePeriodPeriod
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity S
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Used when reporting vital signs panel components
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Related measurements the observation is made from
... component SΣC0..*BackboneElement(USCDI) Component observations
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

.... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantityQuantity S
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensibleUsCoreVitalSigns
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-3errorObservation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-3errorObservation.componentIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

This structure is derived from observation-vitalsigns

Summary

Mandatory: 5 elements
Must-Support: 15 elements
Fixed Value: 2 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Observation.category is sliced based on the values of value:coding.code, value:coding.system

 

Other representations of profile: CSV, Excel, Schematron

Notes:


Quick Start


Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

  • The syntax used to describe the interactions is described here.

  • Servers providing access to vital signs data can use US Core SMART Scopes for:
    • resource level scopes (for example, patient/Observation.rs)
    • granular scopes (for example, patient.Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs).
  • See the General Requirements section for additional rules and expectations when a server requires status parameters.
  • See the General Guidance section for additional guidance on searching for multiple patients.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

  1. SHALL support searching using the combination of the patient and category search parameters:

    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = vital-signs (how to search by reference and how to search by token)

  2. SHALL support searching using the combination of the patient and code search parameters:
    • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

    GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/Observation?patient=1186747&code=http://loinc.org|8867-4,http://loinc.org|9279-1,http://loinc.org|85354-9

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The Observation code parameter searches `Observation.code only. (how to search by reference and how to search by token)

  3. SHALL support searching using the combination of the patient and category and date search parameters:
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date=ge2020-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = vital-signs (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

  1. SHOULD support searching using the combination of the patient and category and status search parameters:
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status=final

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and status (how to search by reference and how to search by token)

  2. SHOULD support searching using the combination of the patient and code and date search parameters:
    • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/Observation?patient=1186747&code=http://loinc.org|8867-4,http://loinc.org|9279-1,http://loinc.org|85354-9&date=ge2020-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple codes. (how to search by reference and how to search by token and how to search by date)