Case Based Surveillance Implementation Guide - Local Development build (v0.2.1). See the Directory of published versions
Resource Profile: Case Based Surveillance Social Determinants of Health Profile
| Official URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-social-determinants-of-health | Version: 0.2.1 | |||
| Active as of 2021-01-01 | Computable Name: CaseBasedSurveillanceSocialDeterminantsOfHealth | |||
This profile sets minimum expectations for the Observation resource to represent data requested as part of the U.S. Public Health Case Based Surveillance messaging guides. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile.
Example Usage Scenarios:
The following are example usage scenarios for the CBS Social Determinants of Health profile:
- Capture characteristics of a subject’s home environment.
- Capture education level.
- Capture data around food insecurity.
- Capture information related to Sexual Orientation and Gender Identity (SOGI) not covered in other profiles and extensions.
Definition of “Social Determinants of Health” in Context
The term “Social Determinants of Health” is broad and lacks a single unifying standard defining exactly what constitutes SDOH data. There is also not always clear lines drawn between potentially causal data and that which captures an effect. For example, discrimination is considered by the U.S. Department of Health and Human Services’ Healthy People 2030 to be SDOH data, though does not specify the underlying reason for the discrimination. For the purposes of this profile, what qualifies as a social determinant of health is left up to individual surveillance programs.
Relationship to CDC Message Mapping Guides
The Center for Disease Control’s (CDC) Message Mapping Guides (MMGs) provide guidance on the transmission of records from jurisdictions to case based surveillance programs. MMG documents are publicly available through the CDC’s website. In addition to generic information captured by the Gen V2 guide, there are program specific guides tied to specific conditions or groups of condition.
The CBS Social Determinants of Health profile provides a categorical means to capture a broad range of data which broadly falls under the umbrella of social determinants of health. Data relevant to a condition specific surveillance program may vary and guidance from programs should be followed.
Relevance of the SDOH Clinical Care IG
The HL7 Gravity Project defines a trial implementation guide for SDOH Clinical Care to represent SDOH Data in clinical settings. It is not directly applicable to case-based surveillance reporting needs as currently defined, but serves a source of standardization in FHIR resources around some structure and coding for SDOH data. This CBS profile draws from the approach taken by the Gravity Project’s IG, though focused around a simplified Observation based reporting workflow rather than capturing full Observation assessments and surveys resulting in findings recorded as Conditions.
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 Profile Definition below provides the formal summary, definitions, and terminology requirements.
Each Observation must have:
- a status
- a category providing a high level representation of the domain of social determinants of health to which the data belongs (e.g. Housing Insecurity or Residence Characteristics)
- a subject reference
- a code
Each Observation must support:
- a value
Profile specific implementation guidance:
- SDOH data which is captured more explicitly in other profiles should prefer not to be included through this profile. This includes subject demographic information in the [US CBS Patient] profile such as Race, Ethnicity, and Gender Identity.
- Programs which collect large amounts of specific SDOH data may prefer utilizing Questionnaire definition and QuestionnaireResponse resources in place of this profile. For example, STD surveillance programs typically ask a series of questions around subject sexual history which is better handled as a discrete entity in Questionnaire and QuestionnaireResponse form.
- This profile supports using the Observation.effective[x] element to capture relevant dates or periods for a subject’s social history. If dates are not known or wish to be avoided due to being Patient Identifying Information, the “Program Specific Time Window” extension may be used to indicate the window the observation falls within in relationship to a given event.
- Occupational Data should utilize the more standardized ODH FHIR Implementation Guide profiles, preferrably the Past or Present Job profile.
Formal Views of Profile Content
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Observation
This structure is derived from Observation
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Observation | 0..* | Observation | Measurements and simple assertions | |
  Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
 us-cbs-program-specific-time-window | 0..1 | (Complex) | US Case Based Surveillance Program Specific Time Window URL: http://cbsig.chai.gatech.edu/StructureDefinition/us-cbs-program-specific-time-window | |
 status | S | 1..1 | code | registered | preliminary | final | amended + |
| category | S | 1..* | CodeableConcept | Classification of type of observation Binding: CBS Case Social Determinants of Health Category Value Set (extensible): Category codes provided for SDOH domains which may be extended by surveillance programs as needed to capture additional data. |
| code | S | 1..1 | CodeableConcept | Type of observation (code / type) Binding: CBS Case Social Determinants of Health Codes Value Set (extensible): Core codes provided for capturing SDOH values which may be extended by surveillance programs as needed to capture additional data. |
 subject | S | 1..1 | Reference(US Case Based Surveillance Patient Profile) | The reference to the subject (the patient) |
 value[x] | S | 0..1 | Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period | Actual result |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Observation | I | 0..* | Observation | Measurements and simple assertions |
 id | Σ | 0..1 | string | Logical id of this artifact |
 meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| us-cbs-program-specific-time-window | 0..1 | (Complex) | US Case Based Surveillance Program Specific Time Window URL: http://cbsig.chai.gatech.edu/StructureDefinition/us-cbs-program-specific-time-window | |
 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. |
| category | S | 1..* | CodeableConcept | Classification of type of observation Binding: CBS Case Social Determinants of Health Category Value Set (extensible): Category codes provided for SDOH domains which may be extended by surveillance programs as needed to capture additional data. |
| code | SΣ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: CBS Case Social Determinants of Health Codes Value Set (extensible): Core codes provided for capturing SDOH values which may be extended by surveillance programs as needed to capture additional data. |
| subject | SΣ | 1..1 | Reference(US Case Based Surveillance Patient Profile) | The reference to the subject (the patient) |
| focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record |
| encounter | Σ | 0..1 | Reference(Encounter) | Healthcare event during which this observation is made |
  effective[x] | Σ | 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 | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) | Who is responsible for the observation |
| value[x] | SΣI | 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 | I | 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 | I | 0..* | BackboneElement | Provides guide for interpretation obs-3: Must have at least a low or a high or text |
| 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 | I | 0..1 | SimpleQuantity | Low Range, if relevant |
| high | I | 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 | I | 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 | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Observation | I | 0..* | Observation | Measurements and simple assertions |
| status | ?!Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation. |
| category | 1..* | CodeableConcept | Classification of type of observation Binding: CBS Case Social Determinants of Health Category Value Set (extensible): Category codes provided for SDOH domains which may be extended by surveillance programs as needed to capture additional data. | |
| code | Σ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: CBS Case Social Determinants of Health Codes Value Set (extensible): Core codes provided for capturing SDOH values which may be extended by surveillance programs as needed to capture additional data. |
| subject | Σ | 1..1 | Reference(US Case Based Surveillance Patient Profile) | The reference to the subject (the patient) |
| value[x] | ΣI | 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 | ||||
This structure is derived from Observation
Differential View
This structure is derived from Observation
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Observation | 0..* | Observation | Measurements and simple assertions | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| us-cbs-program-specific-time-window | 0..1 | (Complex) | US Case Based Surveillance Program Specific Time Window URL: http://cbsig.chai.gatech.edu/StructureDefinition/us-cbs-program-specific-time-window | |
| status | S | 1..1 | code | registered | preliminary | final | amended + |
| category | S | 1..* | CodeableConcept | Classification of type of observation Binding: CBS Case Social Determinants of Health Category Value Set (extensible): Category codes provided for SDOH domains which may be extended by surveillance programs as needed to capture additional data. |
| code | S | 1..1 | CodeableConcept | Type of observation (code / type) Binding: CBS Case Social Determinants of Health Codes Value Set (extensible): Core codes provided for capturing SDOH values which may be extended by surveillance programs as needed to capture additional data. |
| subject | S | 1..1 | Reference(US Case Based Surveillance Patient Profile) | The reference to the subject (the patient) |
| value[x] | S | 0..1 | Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period | Actual result |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Observation | I | 0..* | Observation | Measurements and simple assertions |
| id | Σ | 0..1 | string | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| us-cbs-program-specific-time-window | 0..1 | (Complex) | US Case Based Surveillance Program Specific Time Window URL: http://cbsig.chai.gatech.edu/StructureDefinition/us-cbs-program-specific-time-window | |
| 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. |
| category | S | 1..* | CodeableConcept | Classification of type of observation Binding: CBS Case Social Determinants of Health Category Value Set (extensible): Category codes provided for SDOH domains which may be extended by surveillance programs as needed to capture additional data. |
| code | SΣ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: CBS Case Social Determinants of Health Codes Value Set (extensible): Core codes provided for capturing SDOH values which may be extended by surveillance programs as needed to capture additional data. |
| subject | SΣ | 1..1 | Reference(US Case Based Surveillance Patient Profile) | The reference to the subject (the patient) |
| focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record |
| encounter | Σ | 0..1 | Reference(Encounter) | Healthcare event during which this observation is made |
| effective[x] | Σ | 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 | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) | Who is responsible for the observation |
| value[x] | SΣI | 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 | I | 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 | I | 0..* | BackboneElement | Provides guide for interpretation obs-3: Must have at least a low or a high or text |
| 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 | I | 0..1 | SimpleQuantity | Low Range, if relevant |
| high | I | 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 | I | 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 | ||||
Other representations of profile: CSV, Excel, Schematron
Terminology Bindings
| Path | Conformance | ValueSet |
| Observation.language | preferred | CommonLanguages Max Binding: AllLanguages |
| Observation.status | required | ObservationStatus |
| Observation.category | extensible | CBSSocialDeterminantsOfHealthCategoryVS |
| Observation.code | extensible | CBSSocialDeterminantsOfHealthVS |
| Observation.dataAbsentReason | extensible | DataAbsentReason |
| Observation.interpretation | extensible | ObservationInterpretationCodes |
| Observation.bodySite | example | SNOMEDCTBodyStructures |
| Observation.method | example | ObservationMethods |
| Observation.referenceRange.type | preferred | ObservationReferenceRangeMeaningCodes |
| Observation.referenceRange.appliesTo | example | ObservationReferenceRangeAppliesToCodes |
| Observation.component.code | example | LOINCCodes |
| Observation.component.dataAbsentReason | extensible | DataAbsentReason |
| Observation.component.interpretation | extensible | ObservationInterpretationCodes |
Constraints
| Id | Grade | Path | Details | Requirements |
| dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | Best Practice | Observation | A resource should have narrative for robust management : text.`div`.exists() | |
| 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() | |
| ele-1 | error | Observation.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Observation.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Observation.extension:programSpecificTimeWindow | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Observation.extension:programSpecificTimeWindow | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Observation.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Observation.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Observation.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.basedOn | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.partOf | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.subject | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.focus | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.encounter | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.effective[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.issued | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.performer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.dataAbsentReason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.interpretation | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.note | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.bodySite | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.method | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.specimen | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.device | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.referenceRange | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| obs-3 | error | Observation.referenceRange | Must have at least a low or a high or text : low.exists() or high.exists() or text.exists() | |
| ele-1 | error | Observation.referenceRange.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Observation.referenceRange.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Observation.referenceRange.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Observation.referenceRange.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Observation.referenceRange.low | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.referenceRange.high | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.referenceRange.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.referenceRange.appliesTo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.referenceRange.age | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.referenceRange.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.hasMember | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.derivedFrom | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.component | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.component.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Observation.component.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Observation.component.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Observation.component.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Observation.component.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.component.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.component.dataAbsentReason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.component.interpretation | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Observation.component.referenceRange | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |