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Observation Mapping

Main section links:

XML HL7 > JSON FHIR

FHIR Observations are used throughout the Structured Record. As a result they are mapped from multiple HL7 components as stated below, where the items in bold are the FHIR Observation resource types, the mapping of which is described in the following sections:

Uncategorised Data (XML HL7 > JSON FHIR)

Uncategorised data is mapped from an ObservationStatement to to an Observation in the following way, if it is not deemed to be an Allergy Intolerance, Blood Pressure or Immunization.

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
id ObservationStatement / id \[@root]
meta.profile[0] fixed value = "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
meta.security When ObservationStatement / confidentialityCode [@code], EhrComposition / confidentialityCode [@code], or any CompoundStatement / ObservationStatement[] / confidentialityCode [@code] is present and has a value of NOPAT. See [Confidentiality Codes](../confidentiality code/README.md) for mapping details.
identifier[0].system "https://PSSAdaptor/{{losingOdsCode}}" - where the {{losingOdsCode}} is the ODS code of the losing practice
identifier[0].value ObservationStatement / id \[@root]
status fixed value = "final"
code ObservationStatement / code as described in the XML > FHIR section of Codeable Concept
subject.reference reference to the mapped Patient
context.reference reference to the associated Encounter (if present)
valueQuantity ObservationStatement / value where ObservationStatement / value [@type] is "PQ" or "IVLPQ"
valueQuantity.unit ObservationStatement / value [@unit] or ObservationStatement / value / (high or low)
valueQuantity.comparator ObservationStatement / value / (high or low) [@inclusive] where ObservationStatement / value [@type] is "IVLPQ"
valueQuantity.extension[0].url fixed value = "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-ValueApproximation-1" 1
valueQuantity.extension[0].value fixed value = true 1
valueString ObservationStatement / value where valueQuantity is not populated
effective(x) 2 ObservationStatement / effectiveTime2 or else ObservationStatement / availibiltyTime [@value] 2
issued ehrCompostion / author / time [@value] 3
performer[0].reference Practitioner referenced in ObservationStatement / participant 4, or else EhrComposition / Participant2
interpretation.coding[0].code ObservationStatement / interpretationCode [@code]
interpretation.coding[0].display ObservationStatement / interpretationCode [@code] - human readable translation i.e. "High", "Low", "Abnormal"
interpretation.coding[0].system fixed value = "http://hl7.org/fhir/v2/0078"
interpretation.text ObservationStatement / interpretationCode / originalText or else ObservationStatement / interpretationCode [@displayName]
comment Concatenated from ObservationStatement / subject / personalRelationship / code
and each ObservationStatement / pertinentInformation / pertinentAnnotation in the sequence defined by ObservationStatement / pertinentInformation / sequenceNumber
referenceRange[index].text ObservationStatement / referenceRange[index] / referenceInterpretationRange / text
referenceRange[index].high.value ObservationStatement / referenceRange\[index] / referenceInterpretationRange / value / high
referenceRange[index].low.value ObservationStatement / referenceRange\[index] / referenceInterpretationRange / value / low
Example JSON 
{
   "resource": {
      "resourceType": "Observation",
      "id": "CF0BAFD7-9E92-4DB5-B7EE-B37DBD30AD93",
      "meta": {
         "profile": [
            "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
         ],
         "security":[
          {
            "system":"http://hl7.org/fhir/v3/ActCode",
            "code":"NOPAT",
            "display":"no disclosure to patient, family or caregivers without attending provider's authorization"
          }
         ]
      },
      "identifier": [
         {
            "system": "https://PSSAdaptor/D5445",
            "value": "CF0BAFD7-9E92-4DB5-B7EE-B37DBD30AD93"
         }
      ],      
      "status": "final",
      "code": {
         "coding": [
            {
               "extension": [
                  {
                     "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-coding-sctdescid",
                     "extension": [
                        {
                           "url": "descriptionId",
                           "valueId": "2564971000000119"
                        },
                        {
                           "url": "descriptionDisplay",
                           "valueString": "Plasma triglyceride level"
                        }
                     ]
                  }
               ],
               "system": "http://snomed.info/sct",
               "code": "1010601000000105",
               "display": "Plasma triglyceride level"
            }
         ],
         "text": "Plasma triglyceride level"
      },
      "subject": {
         "reference": "Patient/bbe0c375-4675-4976-8586-597056863ac7"
      },
      "context": {
         "reference": "Encounter/E92099A9-F7E9-4684-91EB-D6427F022041"
      },
      "effectiveDateTime": "2010-01-14T13:08:00+00:00",
      "issued": "2010-02-06T13:07:44.000+00:00",
      "performer": [
         {
            "reference": "Practitioner/C5DEFBF3-0174-BC6F-182C-B777B9C6FF43"
         }
      ],
      "valueQuantity": {
         "value": 10,
         "unit": "millimole per liter",
         "code": "mmol/L"
      },
      "interpretation": {
         "coding": [
            {
               "system": "http://hl7.org/fhir/v2/0078"
            }
         ],
         "text": "Potentially abnormal"
      },
      "comment": "Less than or equal to 5 and abnormal",
      "referenceRange": [
         {
            "low": {
               "value": 5
            }
         }
      ]
   }
}
  1. If ObservationStatement / uncertaintyCode is present.
  2. Where ObservationStatement / effectiveTime does not contain the center element but does contain either low or high the values are mapped to effectivePeriod.start and effectivePeriod.end respectfully. Otherwise, ObservationStatement / effectiveTime / center or else ObservationStatement / availibiltyTime [@value] are mapped to effectiveDateTime.
  3. Where the ehrComposition is the parent of mapped statement.
  4. Where participant [@typecode] is "PPRF" (Primary performer) or "PRF" (Performer).

Blood Pressure (XML HL7 > JSON FHIR)

Blood pressure observations are mapped from a HL7 CompoundStatement containing two ObservationStatement components, known as a "blood pressure triple", where the SNOMED codes identify them as a blood pressure. The SNOMED codes used to identify a "blood pressure triple" are listed in the GP Connect documentation .

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
id CompoundStatement / id [@root]
meta.profile[0] fixed value = "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
meta.security When CompoundStatement / confidentialityCode [@code], EhrComposition / confidentialityCode [@code], or any CompoundStatement / ObservationStatement[] / confidentialityCode [@code] is present and has a value of NOPAT. See [Confidentiality Codes](../confidentiality code/README.md) for mapping details.
identifier[0].system "https://PSSAdaptor/{{losingOdsCode}}" - where the {{losingOdsCode}} is the ODS code of the losing practice
identifier[0].value CompoundStatement / id \[@root]
status fixed value = "final"
code CompoundStatement / code as described in the XML > FHIR section of Codeable Concept
subject.reference reference to the mapped Patient
context.reference reference to the associated Encounter (if present)
effective(x) 2 CompoundStatement / effectiveTime 2 or else CompoundStatement / availibiltyTime [@value] 2
issued ehrCompostion / author / time [@value] 3
performer[0].reference Practitioner referenced in CompoundStatement / participant 4, or else EhrComposition / Participant2
component[index].code ObservationStatement.code 5 as described in the XML > FHIR section of Codeable Concept
component[index].valueQuantity ObservationStatement / value where ObservationStatement / value [@type] is "PQ" or "IVLPQ" 5
component[index].valueQuantity.extension[0].url fixed value = "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-ValueApproximation-1" 1
component[index].valueQuantity.extension[0].value fixed value = true 1
component[index].interpretation.coding[0].code ObservationStatement / interpretationCode [@code]
component[index].interpretation.coding[0].display ObservationStatement / interpretationCode [@code] - human readable translation i.e. "High", "Low", "Abnormal"
component[index].interpretation.coding[0].system fixed value = "http://hl7.org/fhir/v2/0078"
component[index].referenceRange[index].text ObservationStatement / referenceRange[index] / referenceInterpretationRange / text
component[index].referenceRange[index].high.value ObservationStatement / referenceRange\[index] / referenceInterpretationRange / value / high
component[index].referenceRange[index].low.value ObservationStatement / referenceRange\[index] / referenceInterpretationRange / value / low
comment concatenated from each ObservationStatement / pertinentInformation / pertinentAnnotation / text 6 and NarrativeStatement / text 7
Qualifiers such as episodicity (SNOMED 288526004) may be added, wrapped in curly brackets.
Example JSON 
{
  "resource": {
    "resourceType": "Observation",
    "id": "F25C1328-B6D2-412F-9C56-A8F21182F100",
    "meta": {
      "profile": [
        "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
      ],
      "security": [
        {
          "system":"http://hl7.org/fhir/v3/ActCode",
          "code":"NOPAT",
          "display":"no disclosure to patient, family or caregivers without attending provider's authorization"
        }
      ]
    },
    "identifier": [
      {
        "system": "https://PSSAdaptor/D5445",
        "value": "F25C1328-B6D2-412F-9C56-A8F21182F100"
      }
    ],    
    "status": "final",
    "code": {
      "coding": [
        {
          "extension": [
            {
              "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-coding-sctdescid",
              "extension": [
                {
                  "url": "descriptionId",
                  "valueId": "254063019"
                },
                {
                  "url": "descriptionDisplay",
                  "valueString": "O/E - blood pressure reading"
                }
              ]
            }
          ],
          "system": "http://snomed.info/sct",
          "code": "163020007",
          "display": "O/E - blood pressure reading"
        }
      ],
      "text": "O/E - blood pressure reading"
    },
    "subject": {
      "reference": "Patient/bbe0c375-4675-4976-8586-597056863ac7"
    },
    "context": {
      "reference": "Encounter/81A3B881-FE23-4346-A7ED-48ED539E9054"
    },
    "effectiveDateTime": "2010-02-06T12:41:00+00:00",
    "issued": "2010-02-06T12:44:53.000+00:00",
    "performer": [
      {
        "reference": "Practitioner/C5DEFBF3-0174-BC6F-182C-B777B9C6FF43"
      }
    ],
    "component": [
      {
        "code": {
          "coding": [
            {
              "extension": [
                {
                  "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-coding-sctdescid",
                  "extension": [
                    {
                      "url": "descriptionDisplay",
                      "valueString": "O/E - Systolic BP reading"
                    }
                  ]
                }
              ],
              "system": "http://snomed.info/sct",
              "code": "72313002",
              "display": "Systolic arterial pressure"
            }
          ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 170,
          "unit": "mmHg"
        }
      },
      {
        "code": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "1091811000000102",
              "display": "O/E - Diastolic BP reading"
            }
          ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 130,
          "unit": "mmHg"
        }
      }
    ],
    "comment": "{Episodicity : code=255217005, displayName=First}"
  }
}
  1. Mapped for the both ObservationStatement elements that form part of the blood pressure triple.
  2. Text from a pertinentAnnotation is prepended with "Systolic Note: " or "Diastolic Note: ", determined by the SNOMED code of the OberservationStatement. If an appropriate code isn't present, it is not mapped.
  3. Where the NarrativeStatement is a child of the blood pressure triple's CompoundStatement. Prepended with "BP Note: " when mapped.

Self Referral (XML HL7 > JSON FHIR)

If a referral is deemed to be a self referral, the HL7 RequestStatement is mapped to an FHIR Observation. Self referrals are identified by RequestStatement / code / qualifier /value [@code], where it is equal to "SelfReferral.

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
id RequestStatement / id [@root]
meta.profile[0] fixed value = "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
meta.security When RequestStatement / confidentialityCode [@code] is present and has a value of NOPAT. See [Confidentiality Codes](../confidentiality code/README.md) for mapping details.
identifier[0].system "https://PSSAdaptor/{{losingOdsCode}}" - where the {{losingOdsCode}} is the ODS code of the losing practice
identifier[0].value RequestStatement / id \[@root]
status fixed value = "final"
code RequestStatement / code as described in the XML > FHIR section of Codeable Concept
issued ehrCompostion / author / time [@value] 3
subject.reference reference to the mapped Patient
context.reference reference to the associated Encounter (if present)
effective(x) 2 RequestStatement / effectiveTime 2 or else RequestStatement / availibiltyTime [@value] 2
performer[0].reference Practitioner referenced in RequestStatement / participant 8, or else EhrComposition / Participant2
comment fixed value = "SelfRerreral"
component[0].code.text fixed value = "Urgency"
component[0].valueString RequestStatement / priorityCode / originalText
component[1].code.text fixed value = "Text"
component[1].valueString RequestStatement / text
Example JSON 
{
  "resource": {
    "resourceType": "Observation",
    "id": "8D61D723-D51D-44FB-B814-0EB69DB1D6F4",
    "meta": {
      "profile": [
        "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
      ],
      "security": [
        {
          "system":"http://hl7.org/fhir/v3/ActCode",
          "code":"NOPAT",
          "display":"no disclosure to patient, family or caregivers without attending provider's authorization"
        }
      ]
    },
    "identifier": [
      {
        "system": "https://PSSAdaptor/D5445",
        "value": "8D61D723-D51D-44FB-B814-0EB69DB1D6F4"
      }
    ],    
    "status": "final",
    "code": {
      "coding": [
        {
          "extension": [
            {
              "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-coding-sctdescid",
              "extension": [
                {
                  "url": "descriptionId",
                  "valueId": "283677016"
                },
                {
                  "url": "descriptionDisplay",
                  "valueString": "Referral to G.P."
                }
              ]
            }
          ],
          "system": "http://snomed.info/sct",
          "code": "183561008",
          "display": "Referral to GP"
        }
      ],
      "text": "Referral to G.P."
    },
    "subject": {
      "reference": "Patient/bed1e27e-0e28-4dea-9216-bc60fa3dc17b"
    },
    "context": {
      "reference": "Encounter/B88EECC1-8DA9-48F9-981F-8D31C517A693"
    },
    "effectiveDateTime": "2010-01-19",
    "issued": "2010-01-19T11:39:57.000+00:00",
    "performer": [
      {
        "reference": "Practitioner/C5DEFBF3-0174-BC6F-182C-B777B9C6FF43"
      }
    ],
    "comment": "SelfReferral",
    "component": [
      {
        "code": {
          "text": "Urgency"
        },
        "valueString": "Routine"
      },
      {
        "code": {
          "text": "Text"
        },
        "valueString": "Dr David McAvenue, Purpose: SelfReferral, Reason: Dry eyes"
      }
    ]
  }
}
  1. Where ObservationStatement / participant [@typecode] is "PPRF" (Primary performer) or "PRF" (Performer).

Investigations

For more information on how Investigations are represented in GP Connect see Investigations Guidance.

Test Group Header (XML HL7 > JSON FHIR)

Test group headers are mapped from a nested CompoundStatement with a class code of BATTERY where the parent compound statements are deemed to from a Diagnostic Report.

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
id CompoundStatement / id [@root]
meta.profile[0] fixed value = "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
meta.security When CompoundStatement / confidentialityCode [@code] is present and has a value of NOPAT. See [Confidentiality Codes](../confidentiality code/README.md) for mapping details.
identifier[0].system "https://PSSAdaptor/{{losingOdsCode}}" - where the {{losingOdsCode}} is the ODS code of the losing practice
identifier[0].value CompoundStatement / id \[@root]
status fixed value = "final"
category[0].coding[0].code fixed value = "laboratory"
category[0].coding[0].system fixed value = "http://hl7.org/fhir/observation-category"
category[0].coding[0].display fixed value = "Laboratory"
code CompoundStatement / code as described in the XML > FHIR section of Codeable Concept
subject.reference reference to the mapped Patient
context.reference reference to the associated Encounter (if present)
effective(x) 2 CompoundStatement / effectiveTime 2 or else CompoundStatement / availibiltyTime [@value] 2
issued ObservationStatement / availabilityTime [@value], or else CompoundStatement / availibiltyTime [@value] for Filed Report, or else ehrCompostion / author / time [@value] 3
performer[0].reference Practitioner referenced in CompoundStatement / participant or else EhrComposition / Participant2
comment concatenated with newlines from child NarrativeStatement / text where the EDIFACT comment type is not USER COMMENT
specimen.reference reference to the Specimen
related[index].type fixed value = "has-member"
related[index].target.reference reference to component Test Result
Example JSON 
{
  "resource": {
    "resourceType": "Observation",
    "id": "2418B6B6-C4C0-46CB-9030-5B7DD39C80FC",
    "meta": {
      "profile": [
        "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
      ],
    "security":[
       {
          "system":"http://hl7.org/fhir/v3/ActCode",
          "code":"NOPAT",
          "display":"no disclosure to patient, family or caregivers without attending provider's authorization"
       }
    ]
    },
    "identifier": [
      {
        "system": "https://PSSAdaptor/D5445",
        "value": "2418B6B6-C4C0-46CB-9030-5B7DD39C80FC"
      }
    ],
    "status": "final",
    "category": [
      {
        "coding": [
          {
            "system": "http://hl7.org/fhir/observation-category",
            "code": "laboratory",
            "display": "Laboratory"
          }
        ]
      }
    ],
    "code": {
      "text": "CHOL/HDL RATIO"
    },
    "subject": {
      "reference": "Patient/80bd1375-a1e3-4137-95ff-fb3316cf3496"
    },
    "context": {
      "reference": "Encounter/1449860E-3953-4D71-A867-3E1E79D2E11B"
    },
    "effectiveDateTime": "2010-01-20T10:46:22+00:00",
    "issued": "2010-03-26T13:49:48.000+00:00",
    "performer": [
      {
        "reference": "Practitioner/1E473786-E7FA-785E-C911-A8D38FB56F20"
      }
    ],
    "comment": "See FATS/Healthy Hearts guidelines for interpretation of lipids",
    "specimen": {
      "reference": "Specimen/92BB4158-8984-4898-8C4D-EBFD27514947"
    },
    "related": [
      {
        "type": "has-member",
        "target": {
          "reference": "Observation/C737A049-F93E-4C52-AFDF-21B0D1C7298C"
        }
      },
      {
        "type": "has-member",
        "target": {
          "reference": "Observation/E47B3A50-EEBE-4336-AA48-5932A01BC1B5"
        }
      },
      {
        "type": "has-member",
        "target": {
          "reference": "Observation/8673E805-9884-4040-993A-D72AECF4D363"
        }
      }
    ]
  }
}

Test Result (XML HL7 > JSON FHIR)

Except for the fields outlined below, Test Result observations are mapped identically to Uncategorised Data.

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
comment concatenated with newlines from child NarrativeStatement / text where the EDIFACT comment type is not USER COMMENT
issued ObservationStatement / availabilityTime [@value] if populated, otherwise the default Uncategorised Data issued mapping
related[index].type fixed value = "derived-from" or fixed value = "has-member"
related[index].target.reference reference to the parent Test Group Header
specimen.reference reference to the Specimen
category[0].coding[0].code fixed value = "laboratory"
category[0].coding[0].system fixed value = "http://hl7.org/fhir/observation-category"
category[0].coding[0].display fixed value = "Laboratory"
Example JSON 
{
  "resource": {
    "resourceType": "Observation",
    "id": "C737A049-F93E-4C52-AFDF-21B0D1C7298C",
    "meta": {
      "profile": [
        "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
      ]
    },
    "identifier": [
      {
        "system": "https://PSSAdaptor/D5445",
        "value": "C737A049-F93E-4C52-AFDF-21B0D1C7298C"
      }
    ],
    "status": "final",
    "category": [
      {
        "coding": [
          {
            "system": "http://hl7.org/fhir/observation-category",
            "code": "laboratory",
            "display": "Laboratory"
          }
        ]
      }
    ],
    "code": {
      "coding": [
        {
          "extension": [
            {
              "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-coding-sctdescid",
              "extension": [
                {
                  "url": "descriptionDisplay",
                  "valueString": "Serum cholesterol"
                }
              ]
            }
          ],
          "system": "http://snomed.info/sct",
          "code": "1005671000000105",
          "display": "Serum cholesterol level"
        }
      ],
      "text": "Serum cholesterol"
    },
    "subject": {
      "reference": "Patient/80bd1375-a1e3-4137-95ff-fb3316cf3496"
    },
    "context": {
      "reference": "Encounter/1449860E-3953-4D71-A867-3E1E79D2E11B"
    },
    "effectiveDateTime": "2010-01-20T10:46:22+00:00",
    "issued": "2010-03-26T13:49:48.000+00:00",
    "performer": [
      {
        "reference": "Practitioner/1E473786-E7FA-785E-C911-A8D38FB56F20"
      }
    ],
    "valueQuantity": {
      "value": 6.3,
      "unit": "millimole per liter",
      "code": "mmol/L"
    },
    "specimen": {
      "reference": "Specimen/92BB4158-8984-4898-8C4D-EBFD27514947"
    },
    "related": [
      {
        "type": "derived-from",
        "target": {
          "reference": "Observation/2418B6B6-C4C0-46CB-9030-5B7DD39C80FC"
        }
      }
    ]
  }
}

Filing Comment (XML HL7 > JSON FHIR)

Filing Comment observations are mapped from NarrativeStatements where they are components of a Test Group Header / Test Result CompoundStatement and the EDIFACT comment type is USER COMMENT. When the NarrativeStatement is contained with a Blood Pressure an additional Filing Comment is not created.

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
id Unique ID generated by the adaptor.
meta.profile[0] fixed value = "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
meta.security When NarrativeStatement / confidentialityCode [@code] is present and has a value of NOPAT. See [Confidentiality Codes](../confidentiality code/README.md) for mapping details.
identifier[0].system "https://PSSAdaptor/{{losingOdsCode}}" - where the {{losingOdsCode}} is the ODS code of the losing practice
identifier[0].value Unique ID generated by the adaptor.
status fixed value = "unknown"
code.coding[0].system fixed value = "http://snomed.info/sct"
code.coding[0].code fixed value = "37331000000100"
code.coding[0].display fixed value = "Comment note"
subject.reference reference to the mapped Patient
context.reference reference to the associated Encounter (if present)
issued CompoundStatement / component / NarrativeStatement / availabilityTime [@value]
performer[0].reference Practitioner referenced in ehrComposition / author / agentRef
effectiveTime ehrComposition / author / time [@value] 3
related[0].type fixed value = "derived-from"
related[0].target.reference reference to the parent Test Group Header or Test Result. Where the filing comments relate to the test report, the reference is made from the test report to the filing comment only and related will not be presented.
Example JSON 
{
  "resource": {
    "resourceType": "Observation",
    "id": "21DB2A74-676A-4C76-9143-C149352E9FAF",
    "meta": {
      "profile": [
        "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
      ],
      "security":[
        {
          "system":"http://hl7.org/fhir/v3/ActCode",
          "code":"NOPAT",
          "display":"no disclosure to patient, family or caregivers without attending provider's authorization"
        }
      ]
    },
    "identifier": [
      {
        "system": "https://PSSAdaptor/D5445",
        "value": "21DB2A74-676A-4C76-9143-C149352E9FAF"
      }
    ],
    "status": "final",
    "code": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "37331000000100",
          "display": "Comment note"
        }
      ]
    },
    "subject": {
      "reference": "Patient/80bd1375-a1e3-4137-95ff-fb3316cf3496"
    },
    "context": {
      "reference": "Encounter/B0696913-F11D-4EAA-8BB7-41350B296F3F"
    },
    "issued": "2010-02-01T09:33:13.000+00:00",
    "performer": [
      {
        "reference": "Practitioner/1E473786-E7FA-785E-C911-A8D38FB56F20"
      }
    ],
    "comment": "(EMISTest) - Normal - No Action",
    "related": [
      {
        "type": "derived-from",
        "target": {
          "reference": "Observation/69832EFE-727E-4270-BDF5-179851BDF295"
        }
      }
    ]
  }
}

Componentised Observations

When a CompoundStatement element has a class code of BATTERY or CLUSTER and does not form part of a Diagnostic Report or a blood pressure, it is mapped to an observation resource. Additionally, any ObservationStatement component will be mapped to a separate Observation and referenced using the "derived-from" / "has-member" relationship.

Componentised observation header (XML HL7 > JSON FHIR)

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
id CompoundStatement / id [@root]
meta.profile[0] fixed value = "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
meta.security When CompoundStatement / confidentialityCode [@code] is present and has a value of NOPAT. See [Confidentiality Codes](../confidentiality code/README.md) for mapping details.
identifier[0].system "https://PSSAdaptor/{{losingOdsCode}}" - where the {{losingOdsCode}} is the ODS code of the losing practice
identifier[0].value CompoundStatement / id \[@root]
status fixed value = "final"
code CompoundStatement / code as described in the XML > FHIR section of Codeable Concept
subject.reference reference to the mapped Patient
context.reference reference to the associated Encounter (if present)
effective(x) 2 CompoundStatement / effectiveTime 2 or else CompoundStatement / availibiltyTime [@value] 2
issued ehrCompostion / author / time [@value] 3
performer[0].reference Practitioner referenced in ObservationStatement / participant 4, or else EhrComposition / Participant2
related[index].type fixed value = "has-member"
related[index].target reference to the child Observation - Test Result
Example JSON 
{
   "resource": {
      "resourceType": "Observation",
      "id": "31465FC9-15B2-4391-A5EF-8F70C2154AAF",
      "meta": {
         "profile": [
            "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
         ],
         "security":[
          {
            "system":"http://hl7.org/fhir/v3/ActCode",
            "code":"NOPAT",
            "display":"no disclosure to patient, family or caregivers without attending provider's authorization"
          }
         ]
      },
      "identifier": [
         {
            "system": "https://PSSAdaptor/D5445",
            "value": "31465FC9-15B2-4391-A5EF-8F70C2154AAF"
         }
      ],
      "status": "final",
      "code": {
         "coding": [
            {
               "extension": [
                  {
                     "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-coding-sctdescid",
                     "extension": [
                        {
                           "url": "descriptionDisplay",
                           "valueString": "Serum lipids"
                        }
                     ]
                  }
               ],
               "system": "http://snomed.info/sct",
               "code": "1005661000000103",
               "display": "Serum lipids level"
            }
         ],
         "text": "Serum lipids"
      },
      "subject": {
         "reference": "Patient/80bd1375-a1e3-4137-95ff-fb3316cf3496"
      },
      "effectiveDateTime": "2001-03-30",
      "issued": "2010-02-09T12:31:51.000+00:00",
      "performer": [
         {
            "reference": "Practitioner/C5DEFBF3-0174-BC6F-182C-B777B9C6FF43"
         }
      ],
      "related": [
         {
            "type": "has-member",
            "target": {
               "reference": "Observation/C45E3DA5-D7BC-4FDF-B4E0-6CCECCE60D24"
            }
         },
         {
            "type": "has-member",
            "target": {
               "reference": "Observation/3BC7ABC9-ABCB-4C01-A519-35CE664C3543"
            }
         }
      ]
   }
}

Componentised Observation (XML HL7 > JSON FHIR)

With the exception of the related field, Componentised Observations are mapped identically to Uncategorised Data.

Mapped to (JSON FHIR Observation resource field) Mapped from (XML HL7 / other)
related[index].type fixed value = "derived-from"
related[index].target reference to the parent Componentised Observation Header)
Example JSON 
{
   "resource": {
      "resourceType": "Observation",
      "id": "C45E3DA5-D7BC-4FDF-B4E0-6CCECCE60D24",
      "meta": {
         "profile": [
            "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
         ]
      },
      "identifier": [
         {
            "system": "https://PSSAdaptor/D5445",
            "value": "C45E3DA5-D7BC-4FDF-B4E0-6CCECCE60D24"
         }
      ],
      "status": "final",
      "code": {
         "coding": [
            {
               "extension": [
                  {
                     "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-coding-sctdescid",
                     "extension": [
                        {
                           "url": "descriptionDisplay",
                           "valueString": "Serum cholesterol"
                        }
                     ]
                  }
               ],
               "system": "http://snomed.info/sct",
               "code": "1005671000000105",
               "display": "Serum cholesterol level"
            }
         ],
         "text": "Serum cholesterol"
      },
      "subject": {
         "reference": "Patient/80bd1375-a1e3-4137-95ff-fb3316cf3496"
      },
      "effectiveDateTime": "2001-03-30",
      "issued": "2010-02-09T12:31:51.000+00:00",
      "performer": [
         {
            "reference": "Practitioner/C5DEFBF3-0174-BC6F-182C-B777B9C6FF43"
         }
      ],
      "valueQuantity": {
         "value": 6.1,
         "unit": "millimole per liter",
         "code": "mmol/L"
      },
      "related": [
         {
            "type": "derived-from",
            "target": {
               "reference": "Observation/31465FC9-15B2-4391-A5EF-8F70C2154AAF"
            }
         }
      ]
   }
}

Unmapped fields

The following Observation fields are not currently populated by the adaptor:

  • implicitRules
  • language
  • text
  • contained
  • modifierExtension
  • identifier.type
  • identifier.use
  • identifier.period
  • identifier.assigner
  • basedOn
  • category.id
  • category.coding.id
  • category.coding.version
  • category.coding.userSelected
  • category.coding.extension
  • category.text
  • subject.id
  • subject.identifier
  • subject.display
  • context.id
  • context.identifier
  • context.display
  • performer.id
  • performer.identifier
  • performer.display
  • dataAbsentReason
  • interpretation.coding.id
  • interpretation.coding.version
  • interpretation.coding.userSelected
  • bodySite
  • method
  • specimen.id
  • specimen.identifier
  • specimen.display
  • device
  • referenceRange.id
  • referenceRange.modifierExtension
  • referenceRange.low.id
  • referenceRange.low.unit
  • referenceRange.low.system
  • referenceRange.low.code
  • referenceRange.high.id
  • referenceRange.high.unit
  • referenceRange.high.system
  • referenceRange.high.code
  • referenceRange.type
  • referenceRange.appliesTo
  • referenceRange.age
  • related.id
  • related.modifierExtension
  • related.target.id
  • related.target.identifier
  • related.target.display
  • component.id
  • component.modifierExtension
  • component.code.id
  • component.dataAbsentReason
  • component.interpretation.id
  • component.interpretation.coding.id
  • component.interpretation.coding.version
  • component.interpretation.coding.userSelected
  • component.interpretation.text

JSON FHIR > XML HL7

FHIR Observations can be mapped to the following HL7 components. The mapping for each GP Connect observation type (in bold) is described in the sections below:

Uncategorised Data (JSON FHIR > XML HL7)

Uncategorised data is mapped from an FHIR Observation to a HL7 ObservationStatement where it is not deemed to be a Blood Pressure or Comment Note.

Mapped to (XML HL7 ObservationStatement) Mapped from (JSON FHIR / other source )
id [@root] Unique ID generated by the adaptor
code Observation.code.coding as described in the FHIR > XML section of Codeable Concept
statusCode fixed value = "COMPLETE"
effectiveTime Observation.effectiveDateTime or else Observation.effectivePeriod
availabilityTime Observation.effectiveDateTime or else Observation.effectivePeriod.start
value Observation.valueQuantity or Observation.valueString
pertinentInformation / sequenceNumber [@value] fixed value = "+1"
pertinentInformation / pertinentAnnotation / text mapped as described in Mapping for Uncategorised Data's Pertinent Information (below)
interpretationCode [@code] Observation.interpretation.coding.code
interpretationCode [@codeSystem] fixed value = "2.16.840.1.113883.2.1.6.5"
interpretationCode [@displayName] description of Observation.interpretation.coding.code e.g. if code = "HI" then displayName = "Above high reference limit"
interpretationCode / originalText Observation.interpretation.coding.display
referenceRange / referenceInterpretationRange / text Observation.referenceRange.text
referenceRange / referenceInterpretationRange / value Observation.referenceRange.value where Observation.refenceRange and Observation.valueQuantity are populated
Participant / agentRef / id [@root] Observation.performer
Example XML 
<ObservationStatement classCode="OBS" moodCode="EVN">
   <id root="1814312A-9F16-4311-AB4F-7E31E7B57E1F"/>
   <code code="478551000006117" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="ALT/SGPT serum level"/>
   <statusCode code="COMPLETE"/>
   <effectiveTime>
      <center value="20100323133700"/>
   </effectiveTime>
   <availabilityTime value="20100323133700"/>
   <value xsi:type="PQ" unit="1" value="12.000">
      <translation value="12.000">
         <originalText>U/L</originalText>
      </translation>
   </value>
   <pertinentInformation typeCode="PERT">
      <sequenceNumber value="+1"/>
      <pertinentAnnotation classCode="OBS" moodCode="EVN">
         <text>BodySite: Example body site comment</text>
      </pertinentAnnotation>
   </pertinentInformation>
   <referenceRange typeCode="REFV">
      <referenceInterpretationRange classCode="OBS" moodCode="EVN.CRT">
         <value>
            <low value="0.000"/>
            <high value="0.300"/>
         </value>
      </referenceInterpretationRange>
   </referenceRange>
   <Participant contextControlCode="OP" typeCode="PRF">
      <agentRef classCode="AGNT">
         <id root="910543AF-6E56-47B9-970F-6724483D808C"/>
      </agentRef>
   </Participant>
</ObservationStatement>

Mapping for Uncategorised Data's Value

The value is mapped from either Observation.valueQuantity or Observation.valueString

In the case of a valueString the resulting observationStatement / value will be produced with <value xsi:type="ST">{{valueString}}</value>

In the case of a valueQuantity, the resulting observationStatement / value will be produced with an xsi:type set to either a PQ (physical quantity) or an IVL_PQ (interval physical quantity), both of which are detailed below.

In the event that a valueQuantity contains an extension with a valueQuantity.extension[].url set to "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-ValueApproximation-1", then an observationStatement.uncertaintyCode will be produced with static values as below:

<uncertaintyCode code="U" codeSystem="2.16.840.1.113883.5.1053" displayName="Recorded as uncertain" />
Physical Quantity

When a valueQuantity.comparator is not provided then the result will be a value with xsi:type='PQ".

When valueQuantity.system is provided with a value of http://unitsofmeasure.org then the result value will be

<value xsi:type="PQ" value="{valueQuantity.value}" unit="{valueQuantity.code}" />

When valueQuantity.system is provided with a value of http://unitsofmeasure.org but no valueQuantity.code is provided then a nested translation, with a nested originalText element will be produced

<value xsi:type="PQ" value="{valueQuantity.value}" unit="1">
                <translation value="{valueQuantity.value}">
                    <originalText>{valueQuantity.unit}</originalText>
                </translation>
</value>

If valueQuantity.system is other than http://unitsofmeasure.org then a nested translation is produced.

<translation value="{valueQuantity.value}" 
             code="{valueQuantity.code}" 
             codeSystem="{valueQuantity.system}" 
             displayName="{valueQuantity.unit}" />

If valueQuantity.system is not present then translation / displayName will not be produced. In the event that valueQuantity.system is not present or is other than http://unitsofmeasure.org and valueSystem.code is not present then an additional value / translation / originalText will be added with the content set to valueQuantity.unit and value \[@unit] will be set to 1.

In all other cases where valueQuantity.code and valueQuantity.unit are not present then the following will be produced:

<value xsi:type="PQ" value="{valueQuantity.value}" unit="1" />

If valueQuantity.value is not provided an observationStatement / value will not be produced.

Interval Physical Quantity

When a valueQuantity.comparator is not provided then the result value will be an interval PQ with xsi:type='IVL_PQ".

The same rules apply to intervals as to standard physical quantities, but with an additional element named either high or low wrapped in the original value element with a property of inclusive.

The additional element will be high when valueQuantity.comparator is either < or <= and conversely will be low when valueQuantity.comparitor is either > or >=.

The inclusive property or of either a value / high or value / low is set with true if valueQuantity.compartor is either <= or >= indicating that the value should be included in comparisons.

An example is provided below:

<value xsi:type="IVL_PQ">
    <high value="37.1" unit="1" inclusive="true">
        <translation value="37.1">
            <originalText>C</originalText>
        </translation>
    </high>
</value>

Mapping for Uncategorised Data's Pertinent Information

The pertinentInformation / pertinentAnnotation / text element is used to map fields that have no direct mapping in the HL7 or add contextual information. Where each field is mapped to a comment it will be prepended as follows:

  • Observation.referenceRange[0].high.unit or low.unit (prepended with Range Units: )
  • Observation.referenceRange[0] where Observation.valueQuantitiy is not populated (prepended with Range: )
  • Observation.interpretation where the interpretation code is unrecognised (prepended with "Interpretation: ")
  • Observation.comment
  • Observation.bodysite (prepended with BodySite: )

Where a Condition references the mapped Observation in the actual problem extension (https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-ActualProblem-1), the following comments can be mapped (prepended with Problem Info: ):

  • Condition.code (prepended with Transformed Observation problem header Originally coded: )
  • Condition.notes (prepended with Problem Notes: and seperated with semicolons)
  • Condition.extension[index].value where extension[index].url equals "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-RelatedProblemHeader-1" (prepended with Related Problem: )

For Observation.value[x], where it is not valueQuantity or valueString one of the following will be mapped

  • Observation.valueCodeableConcept.coding.code and .display (prepended with Code Value: )
  • Observation.valueBoolean (prepended with Boolean Value: )
  • Observation.valueRange (prepended with Range Value: )
  • Observation.valueRatio.numerator and .denominator (prepended with Ratio Value: )
  • Observation.valueTimeType (prepended with Time Value: )
  • Observation.valueDateTimeType (prepended with DateTime Value: )
  • Observation.valuePeriod.start and .end (formatted as Period Value: Start {{start}} End {{end}})

The following values will be grouped and appended with "Component(s): and enclosed in square brackets

  • Observation.component.valueQuantity (prepended with Quantity Value: )
  • Observation.component.valueString (prepended with String Value: )
  • Observation.component.valueCodeableConcept.coding.code and .display (prepended with Code Value: )
  • Observation.component.valueBoolean (prepended with Boolean Value: )
  • Observation.component.valueRange (prepended with Range Value: )
  • Observation.component.valueRatio.numerator and .denominator (prepended with Ratio Value: )
  • Observation.component.valueTimeType (prepended with Time Value: )
  • Observation.component.valueDateTimeType (prepended with DateTime Value: )
  • Observation.component.valuePeriod.start and .end (formatted as Period Value: Start {{start}} End {{end}})
  • Observation.component.code (prepended with code: )
  • Observation.component.interpretation.coding[index].code (prepended with Interpretation Code: ), where coding[index].userSelected is preferred otherwise the first repetition is used
  • Observation.component.interpretation.text (prepended with Interpretation Text: )
  • Observation.component.referenceRange (prepended with Range: )

Blood Pressure (JSON FHIR > XML HL7)

An Observation is identified as a Blood Pressure if Observation.code, Observation.component[0].code and Observation.component[1].code contain a valid blood pressure triple, as outlined in the GP Connect Documentation. Blood Pressure triples are mapped to a CompoundStatement with ObservationStatement components for the systolic and diastolic readings and a optional NarrativeStatement for additional information.

If Blood pressure observations do not form a valid triple they will be mapped as Unategorised Observations

Parent Compound Statement

Mapped to (XML HL7 CompoundStatement) Mapped from (JSON FHIR / other source )
id Unique ID generated by the adaptor
code [@code] Observation.code.coding[0].code
code [@displayName] Observation.code.coding[0].display
code [@codeSystem] fixed value = "2.16.840.1.113883.2.1.3.2.4.15"
code / originalText coding.text
or else coding.display
or else coding.extension[index].value where coding.extension[index].url equals "descriptionDisplay"
statusCode fixed value = "COMPLETE"
effectiveTime Observation.effectiveDateTime or else Observation.effectivePeriod
availabilityTime [@value] Observation.effectiveDateTime or else Observation.effectivePeriod.start
Participant [@typecode] fixed value = "PRF"
Participant / agentRef / id [@root] Observation.performer[0]

Observation components

The blood pressure will have two ObservationStatement components for the systolic and diastolic readings or to complete the GP Connect triple, as outlined in the GP Connect Documentation.

Mapped to (XML HL7 CompoundStatement / component / ObservationStatement) Mapped from (JSON FHIR / other source )
id Unique ID generated by the adaptor
code [@code] Observation.component[index].code.coding[0].code where the code is a valid systolic or diastolic blood pressure SNOMED code
code [@displayName] Observation.component[index].code.coding[0].display
code [@codeSystem] fixed value = "2.16.840.1.113883.2.1.3.2.4.15"
code / originalText component[index].code.coding.text
or else component[index].code.coding.display
or else component[index].code.coding.extension[index2].value where component[index].code.coding.extension[index2].url equals "descriptionDisplay"
statusCode fixed value = "COMPLETE"
effectiveTime same as the Parent Compound Statement's effectiveTime
availabilityTime [@value] same as the Parent Compound Statement's availabilityTime
value Observation.component[index].valueQuantity
referenceRange / referenceInterpretationRange / text Observation.component[index].referenceRange[0].text
referenceRange / referenceInterpretationRang / value Observation.component[index].referenceRange[0].value

Narrative Statement components

A blood pressure may have a NarrativeStatement component if the parent observation has a comment or if Observation.component.dataAbsentReason, Observation.bodySite or Observation.component.interpretation are populated.

Mapped to (XML HL7 CompoundStatement / component / NarrativeStatement) Mapped from (JSON FHIR / other source )
id Unique ID generated by the adaptor
text Concatenated from Observation.comment, Observation.bodySite, Observation.component.dataAbsentReason and Observation.component.interpretation
statusCode fixed value = "COMPLETE"
availabilityTime [@value] same as the Parent Compound Statement's availabilityTime
Example XML 
<CompoundStatement classCode="BATTERY" moodCode="EVN">
   <id root="CC276BF8-4B61-4388-9C73-38A22A52852F"/>
   <code code="163020007" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="O/E - blood pressure reading">
      <originalText>O/E - blood pressure reading</originalText>
   </code>
   <statusCode code="COMPLETE"/>
   <effectiveTime>
      <center value="20100206124100"/>
   </effectiveTime>
   <availabilityTime value="20100206124100"/>
   <component contextConductionInd="true" typeCode="COMP">
      <ObservationStatement classCode="OBS" moodCode="EVN">
         <id root="2C0CE794-06A6-47FA-85A1-CC8DA5D07E32"/>
         <code code="72313002" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="Systolic arterial pressure">
            <originalText>Systolic blood pressure</originalText>
         </code>
         <statusCode code="COMPLETE"/>
         <effectiveTime>
            <center value="20100206124100"/>
         </effectiveTime>
         <availabilityTime value="20100206124100"/>
         <value unit="1" value="170.000" xsi:type="PQ">
            <translation value="170.000">
               <originalText>mm[Hg]</originalText>
            </translation>
         </value>
      </ObservationStatement>
   </component>
   <component contextConductionInd="true" typeCode="COMP">
      <ObservationStatement classCode="OBS" moodCode="EVN">
         <id root="CF04EB19-F04C-42DD-A450-67B30F7E8A16"/>
         <code code="1091811000000102" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="Diastolic arterial pressure">
            <originalText>Diastolic blood pressure</originalText>
         </code>
         <statusCode code="COMPLETE"/>
         <effectiveTime>
            <center value="20100206124100"/>
         </effectiveTime>
         <availabilityTime value="20100206124100"/>
         <value unit="1" value="130.000" xsi:type="PQ">
            <translation value="130.000">
               <originalText>mm[Hg]</originalText>
            </translation>
         </value>
      </ObservationStatement>
   </component>
   <component contextConductionInd="true" typeCode="COMP">
      <NarrativeStatement classCode="OBS" moodCode="EVN">
         <id root="36A43E4C-9EB5-414C-B549-30B1C728E330"/>
         <text>Measurement Site: test body site</text>
         <statusCode code="COMPLETE"/>
         <availabilityTime value="20100206124100"/>
      </NarrativeStatement>
   </component>
   <Participant contextControlCode="OP" typeCode="PRF">
      <agentRef classCode="AGNT">
         <id root="D2CABB3B-43CB-4461-AC2C-1844AFB8354A"/>
      </agentRef>
   </Participant>
</CompoundStatement>

Comment Note (JSON FHIR > XML HL7)

Where a FHIR Observation resource is coded as a Comment Note (37331000000100) and it is not part of an investigation, it is mapped to a HL7 NarrativeStatement as follows.

Mapped to (XML HL7 NarrativeStatement) Mapped from (JSON FHIR / other source )
id Unique ID generated by the adaptor
text Observation.comment
statusCode fixed value = "COMPLETE"
availabilityTime [@value] Observation.effectiveDateTime or else Observation.effectivePeriod.start or else Observation.issued
Participant [@typecode] fixed value = "PRF"
Participant / agentRef / id [@root] Observation.performer[0]
Example XML 
<NarrativeStatement classCode="OBS" moodCode="EVN">
   <id root="D2FD6804-2CB9-48D7-950E-E616661C887C"/>
   <text>This is a free text note under history</text>
   <statusCode code="COMPLETE"/>
   <availabilityTime value="20100206124100"/>
   <Participant typeCode="PRF" contextControlCode="OP">
      <agentRef classCode="AGNT">
         <id root="6D6BF46C-476B-4955-AE07-CB53C1D9CC40"/>
      </agentRef>
   </Participant>
</NarrativeStatement>

Investigations

The Test Group / Result structure is itself nested as a component of the Specimen compoundStatement (not shown here), which forms part of the Diagnostic Report structure.

Test Group Header (JSON FHIR > XML HL7)

A Test Group Header is mapped to a CompoundStatement with a classcode of "BATTERY", Test Results can be nested as components of the header.

Mapped to (XML HL7 CompoundStatement) Mapped from (JSON FHIR / other source )
id Unique ID generated by the adaptor
code Observation.code.coding as described in Codeable Concept
statusCode fixed value = "COMPLETE"
effectiveTime Observation.effectiveDateTime or else Observation.effectivePeriod
availabilityTime Observation.effectiveDateTime or else Observation.effectivePeriod.start
component[index] / ObservationStatement Mapped Test Results
component[index] / CompoundStatement Mapped Test Results
component[index] / NarrativeStatement Mapped from Observation as outlined in Narrative statement mapping for Test Group Header and Test Result 9 and Filing comments
Example XML 
<CompoundStatement classCode="BATTERY" moodCode="EVN">
   <id root="1022BBB9-5DD2-439A-BB78-9227B36D8BC6"/>
   <code code="196411000000103" codeSystem="2.16.840.1.113883.2.1.3.2.4.15"
         displayName="Transfer-degraded record entry">
      <originalText>CHOL/HDL RATIO</originalText>
   </code>
   <statusCode code="COMPLETE"/>
   <effectiveTime>
      <center value="20050315"/>
   </effectiveTime>
   <availabilityTime value="20050315"/>
   <component contextConductionInd="true" typeCode="COMP">
      <NarrativeStatement classCode="OBS" moodCode="EVN">
         <id root="51962DA9-87DB-4054-A301-A0674BF62FA4"/>
         <text mediaType="text/x-h7uk-pmip">CommentType:AGGREGATE COMMENT SET
CommentDate:20050315

See FATS/Healthy Hearts guidelines for interpretation of lipids</text>
         <statusCode code="COMPLETE"/>
         <availabilityTime value="20050315"/>
      </NarrativeStatement>
   </component>
   <component contextConductionInd="true" typeCode="COMP">
 
      ...
      
   </component>
   <component contextConductionInd="true" typeCode="COMP">

      ...

   </component>

</CompoundStatement>
  • note - the Transfer-degraded record entry was present in the FHIR, it has not been added by the Adaptor.
  1. NarrativeStatement components are created for each of the fields stated in Observation Fields mapped to Narrative Statement above. If none of these fields are present, and no Filing Comments are present the NarrativeStatement will be omitted.

Narrative statement mapping for Test Group Header and Test Result

Where stated in the Test Group Header and Test Result mapping, a collection of NarrativeStatement components may be used to preserve data. Where this takes place, they will be mapped from the appropriate Observation in the following way:

Mapped to (XML HL7 NarrativeStatement) Mapped from (JSON FHIR / other source )
id Unique ID generated by the adaptor
text [@mediaType] fixed value = "text/x-h7uk-pmip"
text An EDIFACT comment type of AGGREGATE COMMENT SET where the content is mapped from one of fields stated below
statusCode fixed value = "COMPLETE"
availabilityTime Same as parent CompoundStatement

Note - this is in addition to filing Comments which also mapped to narrative statements and described below

Observation fields mapped to Narrative Statement

Where multiple fields are stated they are concatenated into a single EDIFACT comment

  • Observation.dataAbsentReason (prefixed with "Data Absent: ")
  • Observation.interpretation (prefixed with "Interpretation: "), comment, valueString (prefixed with "Value: "), Observation.referenceRange[0].text (prefixed with "Range Text: ") and referenceRange[0].high.unit or referenceRange[0].low.unit (prefixed with "Range Units: ")
  • Observation.bodySite (prefixed with "Site: ")
  • Observation.method (prefixed with "Method: ")

Test Result (JSON FHIR > XML HL7)

A Test Result Observation is mapped to an ObservationStatement.

Where a NarrativeStatement is used to preserve data from an Observation, the ObservationStatement and NarrativeStatement will be wrapped in a CompoundStatement with a class code of CLUSTER. Mapping for the narrative statement is described in Narrative statement mapping for Test Group Header and Test Result

Observation statement

Mapped to (XML HL7 ObservationStatement) Mapped from (JSON FHIR / other source )
id [@root] Unique ID generated by the adaptor
code Observation.code.coding as described in Codeable Concept
statusCode fixed value = "COMPLETE"
effectiveTime Observation.effectiveDateTime or else Observation.effectivePeriod
availabilityTime Observation.effectiveDateTime or else Observation.effectivePeriod.start
value Observation.valueQuantity or Observation.valueString
interpretationCode [@code] Observation.interpretation.coding.code
interpretationCode [@codeSystem] fixed value = "2.16.840.1.113883.2.1.6.5"
interpretationCode [@displayName] description of Observation.interpretation.coding.code e.g. if code = "HI" then displayName = "Above high reference limit"
interpretationCode / originalText Observation.interpretation.coding.display
referenceRange / referenceInterpretationRange / text Observation.referenceRange.text
referenceRange / referenceInterpretationRang / value Observation.referenceRange.value

Compound Statement Wrapper

Mapped to (XML HL7 CompoundStatement) Mapped from (JSON FHIR / other source )
id [@root] Unique ID generated by the adaptor
code Observation.code.coding as described in Codeable Concept
statusCode fixed value = "COMPLETE"
effectiveTime Observation.effectiveDateTime or else Observation.effectivePeriod
availabilityTime Observation.effectiveDateTime or else Observation.effectivePeriod.start
component / ObservationStatement The Observation Statement as mapped above
component / NarrativeStatement Mapped from Observation as outlined in Narrative statement mapping for Test Group Header and Test Result 9 and Filing Comments
Example XML 
<CompoundStatement classCode="CLUSTER" moodCode="EVN">
   <id root="5F2D05CF-8FF5-42EC-9130-1E707921257A"/>
   <code code="2551271000000118" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="Serum cholesterol level"/>
   <statusCode code="COMPLETE"/>
   <effectiveTime>
      <center value="20050315"/>
   </effectiveTime>
   <availabilityTime value="20050315"/>
   <component contextConductionInd="true" typeCode="COMP">
      <ObservationStatement classCode="OBS" moodCode="EVN">
         <id root="237E66DB-5FA8-4057-B295-7A0DFFF5173E"/>
         <code code="2551271000000118" codeSystem="2.16.840.1.113883.2.1.3.2.4.15"
               displayName="Serum cholesterol level"/>
         <statusCode code="COMPLETE"/>
         <effectiveTime>
            <center value="20050315"/>
         </effectiveTime>
         <availabilityTime value="20050315"/>
         <value unit="1" value="6.300" xsi:type="PQ">
            <translation value="6.300">
               <originalText>mmol/L</originalText>
            </translation>
         </value>
      </ObservationStatement>
   </component>
   <component contextConductionInd="true" typeCode="COMP">
      <NarrativeStatement classCode="OBS" moodCode="EVN">
         <id root="90A3BE12-0D75-49C8-9387-FEF7FF027378"/>
         <text mediaType="text/x-h7uk-pmip">CommentType:AGGREGATE COMMENT SET
CommentDate:20050315

ReportStatus: Supplementary result
         </text>
         <statusCode code="COMPLETE"/>
         <availabilityTime value="20050315"/>
      </NarrativeStatement>
   </component>
</CompoundStatement>

Filing Comment (JSON FHIR > XML HL7)

Where Test Result Headers or Test Results have Observations coded as Comment Note, the referenced Observation is a Filing Comment. Filing Comments are mapped to NarrativeStatements and inserted as components of the Test Group Header / Test Result CompoundStatement.

Mapped to (XML HL7 NarrativeStatement) Mapped from (JSON FHIR / other source )
id [@root] Unique ID generated by the adaptor
text [@mediaType] fixed value = "text/x-h7uk-pmip"
text EDIFACT comment type of USER COMMENT where the comment body is mapped from Observation.comment 10
availabilityTime Observation.effectiveDateTime or else Observation.effectivePeriod.start
Example XML 
<NarrativeStatement classCode="OBS" moodCode="EVN">
   <id root="9E25E6E1-6799-454B-89E0-57C1952828D4"/>
   <text mediaType="text/x-h7uk-pmip">CommentType:USER COMMENT
CommentDate:20100326134545

(EMISTest) - Normal - No Action</text>
   <statusCode code="COMPLETE"/>
   <availabilityTime value="20100326134545"/>
</NarrativeStatement>
  1. If there is more than one filing comment for a given Observation, the comments are seperated by newlines and appended to the EDIFACT comment body.

Further documentation

GP Connect Uncategorised data

GP Connect Investigations

HL7v3 MIM