SDOH Clinical Care
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StructureDefinition: SDOHCC_Observation_FoodInsecurity_1

This profile supports Gravity Project data elements that focus on the Food Insecurity domain. The profile constrains Observations related to: Food Insecurity. It allows the creation of Observations of: Food insecurity unknown, Food insecurity absent (aka Food security present), Food insecurity present, Mild food insecurity present, Moderate food insecurity present, and Severe food insecurity present.

The official URL for this profile is: 

http://hl7.org/fhir/us/sdoh-cc/StructureDefinition/SDOHCC-Observation-FoodInsecurity-1

Additional Guidance

The FHIR Observation, Condition and Goal resources reference one another. Therefore, to support interoperability and analytics, similar approaches have been used in the structured representation of food insecurity observations, conditions and goals.

The diagram below shows an example of a relationship between Observation, Condition and Goal.

An initial Observation (1) is evidence for a Condition (2) that is addressed by a Goal (3) that may have an outcome of a later Observation (4).

The sections that follow provide additional guidance on 1) rules to improve the integrity of data generated by this profile, 2) specific elements of this profile, and 3) efforts to align the profile with the following correlated Condition and Goal profiles:

  • SDOHCC_Condition_FoodInsecurity_1
  • SDOHCC_Goal_FoodInsecurity_1

Observation.code

This element references sdohcc_ValueSet_FoodInsecurity_1. This value set contains the existing and temporary SNOMED CT codes listed below.

Code Display
733423003 Food insecurity (finding)
sdohcc-sctt-21000243108 Mild food insecurity (finding)
sdohcc-sctt-31000243105 Moderate food insecurity (finding)
sdohcc-sctt-41000243104 Severe food insecurity (finding)

The above options allow a general Food insecurity observation or a more specific Food insecurity observation (e.g., mild, moderate, or severe).

This value set is also used for:

  • Condition.code in SDOHCC_Condition_FoodInsecurity_1

The consistent use of similar codes for a condition and an observation referenced as evidence for that condition will facilitate analytics and interoperability between Observation and Condition.

Example:

  • SDOHCC_Condition_FoodInsecurity_1 modeled with:
    • Condition code = Mild food insecurity

aligns with the observation that this condition references (via Condition.evidence.detail):

  • SDOHCC_Observation_FoodInsecurity_1 modeled with:
    • Observation code = Mild food insecurity
    • Observation value = Known present

Observation.dataAbsentReason

This element references SDOHCC_ValueSet_ContextValue_2. The value set contains the three codes listed below which represent a subset of the FHIR DataAbsentReason value set.

Code Display
unknown Unknown
asked-unknown Asked But Unknown
asked-declined Asked But Declined

Observation.value

This element references SDOHCC_ValueSet_ContextValue_1. This value set contains the SNOMED CT codes listed below.

Code Display
410516002 Known absent (qualifier value)
410515003 Known present (qualifier value)

“Unknown” is not a member of the value set for Observation.value because “Unknown” is included in the FHIR value set for Observation.dataAbsentReason. Therefore, offering an alternative approach for representing that an Observation result is “Unknown” might impact semantic interoperability.

The Known absent (qualifier value) code in this value set is also used as a value for:
• Goal.target.detail in SDOHCC_Goal_FoodInsecurity_1

The consistent use of similar codes for a goal and an observation referenced as an outcome for that goal will facilitate analytics and interoperability between Observation and Goal.

Example:

  • SDOHCC_Observation_FoodInsecurity_1 modeled with:
    • Observation code = Food insecurity
    • Observation value = Known absent

aligns with the goal that references this observation (via Goal.outcomeReference):

  • SDOHCC_Goal_FoodInsecurity_1 modeled with:
    • Goal description: Food security
      and
    • Goal target measure = Food insecurity
    • Goal target detail = Known absent

Observation.effective

This element is constrained to dateTime or Period.

“dateTime” can be used to document that the observation is effective during the specified dateTime but cannot extend to future times. If “dateTime” is used for food insecurity, it is probably best handled by using by a lower precision representation (e.g., month/year or year) as opposed to a higher precision representation (e.g., year/month/date/hour/min). Additionally, dateTime does not confirm or negate the existence of the observation at any time other than the specified dateTime.

“Period” can be used to document that the observation is effective during the specified Period but does not confirm or negate the existence of the observation at any time other than the specified Period. Period can have a “start” and an “end” time. However, for this profile, “start” time is optional (open-ended) but “end” time is mandatory and cannot extend to future times.

The mandating of “end” time is still under discussion at the time of this IG. Therefore, fhirpath rules have not been added to enforce this.

FHIRPath rules

This profile will use FHIRPath rules. The objective of the FHIRPath rules are to support creation of observations that clearly establish a patient’s food insecurity state.

Example: Moderate food insecurity = known present

FHIRPath rules will constrain the observations that can be created with this profile to:

  • Food insecurity = unknown (and subtypes):
    • Food insecurity = asked-unknown
    • Food insecurity = asked-declined
  • Food insecurity = known absent (Essentially the equivalent of “Food security known present”.)
  • Food insecurity = known present (and subtypes):
    • Mild food insecurity = known present
    • Moderate food insecurity= known present
    • Severe food insecurity = known present

Rules:

  1. Observation.value or Observation.dataAbsentReason, but NOT both, MUST be provided.
    This rule prohibits creation of nonsense observations like “Food insecurity = known present AND unknown”.
  2. “Observation.value = Known absent” can only be used with “Observation.code = Food insecurity”.
    This rule prohibits creation of observations like “Mild food insecurity = Known absent” which merely exclude a possible food insecurity state rather than clearly establish a patient’s food insecurity state.
    This rule allows creation of the observation “Food insecurity = known absent” which implies that all states of food insecurity (including mild, moderate and severe) are absent. This clearly establishes that the patient is not in a food insecure state (e.g., equates to “Food security = known present”).
  3. Observation.dataAbsentReason can only be used with “Observation.code = Food insecurity”
    This rule prohibits creation of observations like “Mild food insecurity = unknown” which merely establish that one possible food insecurity state is unknown.
    This rule allows creation of observations like “Food insecurity = unknown” which imply that all states of food insecurity (including mild, moderate and severe) are unknown.

Formal Views of Profile Content

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

This structure is derived from Observation

Summary

Mandatory: 5 elements
Must-Support: 6 elements
Fixed Value: 1 element
Prohibited: 9 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 value of pattern:$this

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*ObservationMeasurements and simple assertions
food-insecurity-1: either Observation.valueCodableConcept or Observation.dataAbsentReason, but NOT both, MUST be provided
food-insecurity-2: Observation.valueCodeableConcept: 'Known absent' MUST only be used with Observation.code: 'Food insecurity'
food-insecurity-3: Observation.dataAbsentReason MUST only be used with Observation.code: 'Food insecurity'
... status S1..1codeFinal
Fixed Value: final
... category S1..*(Slice Definition)Classification of type of observation
Slice: Unordered, Open by pattern:$this
.... category:foodInsecurityCategory S1..1CodeableConceptClassification of type of observation
Required Pattern: At least the following
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: social-history
... code S1..1CodeableConceptType of observation (code / type)
Binding: SDOHCC_ValueSet_FoodInsecurity_1 (required)
... focus 0..0
... encounter S0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] 1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... performer 1..1Reference(Practitioner | PractitionerRole)Who is responsible for the observation
... value[x] 0..1CodeableConceptActual result
Binding: SDOHCC_ValueSet_ContextValue_1 (required)
... dataAbsentReason 0..1CodeableConceptWhy the result is missing
Binding: SDOHCC_ValueSet_ContextValue_2 (required)
... interpretation 0..0
... note
.... author[x] 0..1Individual responsible for the annotation
..... authorReferenceReference(Practitioner)
..... authorStringstring
... bodySite 0..0
... method 0..0
... specimen 0..0
... device 0..0
... referenceRange 0..0
... hasMember 0..0
... derivedFrom 0..*Reference(SDC Questionnaire Response | Observation | DocumentReference)Related measurements the observation is made from
... component 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*ObservationMeasurements and simple assertions
food-insecurity-1: either Observation.valueCodableConcept or Observation.dataAbsentReason, but NOT both, MUST be provided
food-insecurity-2: Observation.valueCodeableConcept: 'Known absent' MUST only be used with Observation.code: 'Food insecurity'
food-insecurity-3: Observation.dataAbsentReason MUST only be used with Observation.code: 'Food insecurity'
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for observation
... basedOn ΣI0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf ΣI0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣI1..1codeFinal
Binding: ObservationStatus (required)
Fixed Value: final
... category SI1..*(Slice Definition)Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: ObservationCategoryCodes (preferred)
.... category:foodInsecurityCategory SI1..1CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version0..1stringVersion of the system - if relevant
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: social-history
...... display0..1stringRepresentation defined by the system
...... userSelected0..1booleanIf this coding was chosen directly by the user
..... text0..1stringPlain text representation of the concept
... code SΣI1..1CodeableConceptType of observation (code / type)
Binding: SDOHCC_ValueSet_FoodInsecurity_1 (required)
... subject SΣI1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... encounter SΣI0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] ΣI1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... issued ΣI0..1instantDate/Time this version was made available
... performer ΣI1..1Reference(Practitioner | PractitionerRole)Who is responsible for the observation
... value[x] ΣI0..1CodeableConceptActual result
Binding: SDOHCC_ValueSet_ContextValue_1 (required)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: SDOHCC_ValueSet_ContextValue_2 (required)
... note I0..*AnnotationComments about the observation
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... author[x] ΣI0..1Individual responsible for the annotation
..... authorReferenceReference(Practitioner)
..... authorStringstring
.... time ΣI0..1dateTimeWhen the annotation was made
.... text ΣI1..1markdownThe annotation - text content (as markdown)
... derivedFrom ΣI0..*Reference(SDC Questionnaire Response | Observation | DocumentReference)Related measurements the observation is made from

doco Documentation for this format

This structure is derived from Observation

Summary

Mandatory: 5 elements
Must-Support: 6 elements
Fixed Value: 1 element
Prohibited: 9 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 value of pattern:$this

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*ObservationMeasurements and simple assertions
food-insecurity-1: either Observation.valueCodableConcept or Observation.dataAbsentReason, but NOT both, MUST be provided
food-insecurity-2: Observation.valueCodeableConcept: 'Known absent' MUST only be used with Observation.code: 'Food insecurity'
food-insecurity-3: Observation.dataAbsentReason MUST only be used with Observation.code: 'Food insecurity'
... status S1..1codeFinal
Fixed Value: final
... category S1..*(Slice Definition)Classification of type of observation
Slice: Unordered, Open by pattern:$this
.... category:foodInsecurityCategory S1..1CodeableConceptClassification of type of observation
Required Pattern: At least the following
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: social-history
... code S1..1CodeableConceptType of observation (code / type)
Binding: SDOHCC_ValueSet_FoodInsecurity_1 (required)
... focus 0..0
... encounter S0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] 1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... performer 1..1Reference(Practitioner | PractitionerRole)Who is responsible for the observation
... value[x] 0..1CodeableConceptActual result
Binding: SDOHCC_ValueSet_ContextValue_1 (required)
... dataAbsentReason 0..1CodeableConceptWhy the result is missing
Binding: SDOHCC_ValueSet_ContextValue_2 (required)
... interpretation 0..0
... note
.... author[x] 0..1Individual responsible for the annotation
..... authorReferenceReference(Practitioner)
..... authorStringstring
... bodySite 0..0
... method 0..0
... specimen 0..0
... device 0..0
... referenceRange 0..0
... hasMember 0..0
... derivedFrom 0..*Reference(SDC Questionnaire Response | Observation | DocumentReference)Related measurements the observation is made from
... component 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*ObservationMeasurements and simple assertions
food-insecurity-1: either Observation.valueCodableConcept or Observation.dataAbsentReason, but NOT both, MUST be provided
food-insecurity-2: Observation.valueCodeableConcept: 'Known absent' MUST only be used with Observation.code: 'Food insecurity'
food-insecurity-3: Observation.dataAbsentReason MUST only be used with Observation.code: 'Food insecurity'
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for observation
... basedOn ΣI0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf ΣI0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣI1..1codeFinal
Binding: ObservationStatus (required)
Fixed Value: final
... category SI1..*(Slice Definition)Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: ObservationCategoryCodes (preferred)
.... category:foodInsecurityCategory SI1..1CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version0..1stringVersion of the system - if relevant
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: social-history
...... display0..1stringRepresentation defined by the system
...... userSelected0..1booleanIf this coding was chosen directly by the user
..... text0..1stringPlain text representation of the concept
... code SΣI1..1CodeableConceptType of observation (code / type)
Binding: SDOHCC_ValueSet_FoodInsecurity_1 (required)
... subject SΣI1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... encounter SΣI0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] ΣI1..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... issued ΣI0..1instantDate/Time this version was made available
... performer ΣI1..1Reference(Practitioner | PractitionerRole)Who is responsible for the observation
... value[x] ΣI0..1CodeableConceptActual result
Binding: SDOHCC_ValueSet_ContextValue_1 (required)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: SDOHCC_ValueSet_ContextValue_2 (required)
... note I0..*AnnotationComments about the observation
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... author[x] ΣI0..1Individual responsible for the annotation
..... authorReferenceReference(Practitioner)
..... authorStringstring
.... time ΣI0..1dateTimeWhen the annotation was made
.... text ΣI1..1markdownThe annotation - text content (as markdown)
... derivedFrom ΣI0..*Reference(SDC Questionnaire Response | Observation | DocumentReference)Related measurements the observation is made from

doco Documentation for this format

 

​Other representations of profile: Schematron

Terminology Bindings

Terminology Bindings

PathConformanceValueSet / Code
Observation.languagepreferredCommonLanguages
Max Binding: AllLanguages
Observation.statusrequiredFixed Value: final
Observation.categorypreferredObservationCategoryCodes
Observation.category:foodInsecurityCategorypreferredPattern: social-history
Observation.coderequiredSDOHCC_ValueSet_FoodInsecurity_1
Observation.value[x]requiredSDOHCC_ValueSet_ContextValue_1
Observation.dataAbsentReasonrequiredSDOHCC_ValueSet_ContextValue_2
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeexampleLOINCCodes
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

Constraints

Constraints

IdPathDetailsRequirements
dom-2ObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3ObservationIf 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-4ObservationIf 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-5ObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6ObservationA resource should have narrative for robust management
: text.`div`.exists()
obs-6ObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7ObservationIf 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()
food-insecurity-1Observationeither Observation.valueCodableConcept or Observation.dataAbsentReason, but NOT both, MUST be provided
: valueCodeableConcept.exists() xor dataAbsentReason.exists()
food-insecurity-2ObservationObservation.valueCodeableConcept: 'Known absent' MUST only be used with Observation.code: 'Food insecurity'
: valueCodeableConcept.coding.where(system = 'http://snomed.info/sct' and code = '410516002').exists() implies code.coding.where(system = 'http://snomed.info/sct' and code = '733423003').exists()
food-insecurity-3ObservationObservation.dataAbsentReason MUST only be used with Observation.code: 'Food insecurity'
: dataAbsentReason.exists() implies code.coding.where(system = 'http://snomed.info/sct' and code = '733423003').exists()
ele-1Observation.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.basedOnAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.partOfAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.category:foodInsecurityCategoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.subjectAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.encounterAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.effective[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.issuedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.performerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.dataAbsentReasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.noteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.note.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.note.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.note.author[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.note.timeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.note.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.referenceRange.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.referenceRange.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.referenceRange.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.referenceRange.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.referenceRange.lowAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.referenceRange.highAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.referenceRange.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.referenceRange.appliesToAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.referenceRange.ageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.referenceRange.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.derivedFromAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.component.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.component.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.component.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Observation.component.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Observation.component.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.component.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.component.dataAbsentReasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.component.interpretationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Observation.component.referenceRangeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())