Purpose

The SHINNY Bundle resource is profiled off of the SDOH Clinical Care Observation Assessment profile, which sets minimum expectations for this Observation resource for searching and fetching an assessment. The Observation Assessment is intended for social risk-related Observations that involve an assessment (e.g., by a provider, payer, etc.) rather than being derived only from question-answer pairs on assessment instruments. This profile identifies core elements, extensions, vocabularies and value sets that SHALL be present when using this resource.

Usage

The Observation Assessment profile is not a required profile.

Including the derivedFrom Reference

When using the Observation Assessment to record a change to a previously completed screening, the derivedFrom reference must be populated with a link back to the original screen or the specific question that was modified from the initial screen. An example of this can be found here, where a change resulted from a provider discussion with the patient which confirmed the original patient response was an error. In this case, the observation.code would represent the original incorrect finding, and the value would be the SNOMED code for “Not Suspected”.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	SDOHCCObservationAssessment	SDOH assessment observation Constraints: obs-6, obs-7, Observation-PerformerOrganizationAssessment
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOH	S	1..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject	SΣ	1..1	Reference(Group | US Core Patient Profile)	Who and/or what the observation is about
encounter	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made
performer	SΣ	1..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
value[x]	SΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern Value: social-history http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationAssessment	error	Observation	All assessment observations must include a performer that references an organization. : (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from SDOHCCObservationAssessment

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	SDOHCCObservationAssessment	SDOH assessment observation Constraints: Observation-PerformerOrganizationAssessment
id	S	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	S	1..1	SHINNYMeta	Metadata about the resource
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
category		2..*	CodeableConcept	Classification of type of observation
Slices for category				Content/Rules for all slices
category:SDOH		1..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity
encounter	S	1..1	Reference(Encounter)	Healthcare event during which this observation is made
performer		1..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.language	preferred	SHINNYLanguageVS http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationAssessment	error	Observation	All assessment observations must include a performer that references an organization. : (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	SDOHCCObservationAssessment	SDOH assessment observation Constraints: obs-6, obs-7, Observation-PerformerOrganizationAssessment
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOH	S	1..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject	SΣ	1..1	Reference(Group | US Core Patient Profile)	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	Σ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	1..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
value[x]	SΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern Value: social-history http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods From the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning From the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationAssessment	error	Observation	All assessment observations must include a performer that references an organization. : (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	SDOHCCObservationAssessment	SDOH assessment observation Constraints: obs-6, obs-7, Observation-PerformerOrganizationAssessment
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOH	S	1..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject	SΣ	1..1	Reference(Group | US Core Patient Profile)	Who and/or what the observation is about
encounter	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made
performer	SΣ	1..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
value[x]	SΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern Value: social-history http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationAssessment	error	Observation	All assessment observations must include a performer that references an organization. : (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Differential View

This structure is derived from SDOHCCObservationAssessment

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	SDOHCCObservationAssessment	SDOH assessment observation Constraints: Observation-PerformerOrganizationAssessment
id	S	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	S	1..1	SHINNYMeta	Metadata about the resource
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
category		2..*	CodeableConcept	Classification of type of observation
Slices for category				Content/Rules for all slices
category:SDOH		1..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity
encounter	S	1..1	Reference(Encounter)	Healthcare event during which this observation is made
performer		1..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.language	preferred	SHINNYLanguageVS http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationAssessment	error	Observation	All assessment observations must include a performer that references an organization. : (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	SDOHCCObservationAssessment	SDOH assessment observation Constraints: obs-6, obs-7, Observation-PerformerOrganizationAssessment
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOH	S	1..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject	SΣ	1..1	Reference(Group | US Core Patient Profile)	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	Σ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	1..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
value[x]	SΣC	0..1		Actual result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern Value: social-history http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods From the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning From the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationAssessment	error	Observation	All assessment observations must include a performer that references an organization. : (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from SDOHCCObservationAssessment

Summary

Mandatory: 5 elements
Must-Support: 3 elements

Structures

This structure refers to these other structures:

• SHINNYMeta (http://test.shinny.org/us/ny/hrsn/StructureDefinition/SHINNYMeta)

Extensions

This structure refers to these extensions:

• http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language