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Latest revision as of 05:11, 7 August 2024

Id2.16.840.1.113883.10.22.4.12Effective Date2017‑03‑21
Other versions this id:
  • Kblank.png IPSRadiologyResultObservation as of 2024‑08‑04 20:18:00
StatusKorange.png Under pre-publication reviewVersion LabelSTU1
NameIPSRadiologyResultObservationDisplay NameIPS Radiology Result Observation
Description
This template represents an observation produced as one of the results of a radiology or other imaging study performed on a patient. 
In most cases, in the context of a patient summary this observation is final and validated, which is recorded with the value "completed" in the statusCode element. Should  the observation be not final, the statusCode would indicate "active", instead.
ContextParent nodes of template element with id 2.16.840.1.113883.10.22.4.12
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Uses
Uses 2 templates
Uses as NameVersion
2.16.840.1.113883.10.22.4.14IncludeKorange.png IPS Body Author (STU1)DYNAMIC
2.16.840.1.113883.10.22.4.22ContainmentKorange.png IPS Comment Activity (STU1)DYNAMIC
RelationshipAdaptation: template 2.16.840.1.113883.10.12.303 CDA Observation (2005‑09‑07)
ref
ad1bbr-

Adaptation: template 2.16.840.1.113883.10.20.22.4.2 Result Observation (V3) (2015‑08‑01)
ref
ccda-

Adaptation: template 2.16.840.1.113883.10.22.4.10 IPS Result Observation (2017‑03‑02)
Example
Example
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.12"/>  <id root="1.2.3.999" extension="__example only__"/>  <code code="..." codeSystem="1.2.3.999"/>  <statusCode code="active"/>  <effectiveTime>
    <low value="20170721091625"/>  </effectiveTime>  <!-- choice: 1..1
element hl7:value
element hl7:value
element hl7:value
-->
  <interpretationCode code="CAR" displayName="Carrier" codeSystem="2.16.840.1.113883.5.83"/>  <methodCode code="..." codeSystem="1.2.3.999"/>  <targetSiteCode>
    <qualifier>
      <name code="272741003" codeSystem="2.16.840.1.113883.6.96" displayName="Laterality"/>      <value code="..." codeSystem="2.16.840.1.113883.6.96"/>    </qualifier>    <qualifier>
      <name code="106233006" codeSystem="2.16.840.1.113883.6.96" displayName="Topographical modifier"/>      <value code="..." codeSystem="2.16.840.1.113883.6.96"/>    </qualifier>  </targetSiteCode>  <author>
    <!-- template 2.16.840.1.113883.10.22.4.14 'IPS Body Author' (dynamic) -->
  </author>  <referenceRange>
    <observationRange>
      <value xsi:type="ANY"/>      <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83" displayName="Normal"/>    </observationRange>  </referenceRange>  <entryRelationship typeCode="COMP">
    <!-- template 2.16.840.1.113883.10.22.4.22 'IPS Comment Activity' (dynamic) -->
  </entryRelationship></observation>
ItemDTCardConfDescriptionLabel
hl7:observation
(IPS...ion)
Treetree.png@classCode
cs1 … 1FOBS
Treetree.png@moodCode
cs1 … 1FEVN
Treetree.pnghl7:templateId
II1 … 1M(IPS...ion)
Treeblank.pngTreetree.png@root
uid1 … 1F2.16.840.1.113883.10.22.4.12
Treetree.pnghl7:id
II0 … *R(IPS...ion)
Treetree.pnghl7:code
CD.IPS (extensible)1 … 1M(IPS...ion)
 CONF
The value of @code should be drawn from value set 2.16.840.1.113883.11.22.40 IPS Results Radiology Observation (DYNAMIC)
Treetree.pnghl7:statusCode
CS1 … 1M(IPS...ion)
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete (DYNAMIC)
Treetree.pnghl7:effectiveTime
IVL_TS1 … 1R(IPS...ion)
Choice1 … 1Elements to choose from:
  • hl7:value[@xsi:type='CE.IPS']
  • hl7:value[@xsi:type='PQ']
  • hl7:value[@xsi:type='IVL_PQ']
  • hl7:value[@xsi:type='ST']
  • hl7:value[@xsi:type='TS']
  • hl7:value[@xsi:type='RTO_QTY_QTY']
Treeblank.pngTreetree.pnghl7:value
CE.IPS0 … 1R(IPS...ion)
where [@xsi:type='CE.IPS']
 Example
Result code: code '201' from code system 2.16.840.1.113883.2.4.4.30.1045
<value xsi:type="CE" code="201" codeSystem="2.16.840.1.113883.2.4.4.30.1045" displayName="regular"/>
 Example
Result code: code 'POS' from code system 2.16.840.1.113883.5.83
<value xsi:type="CE" code="POS" codeSystem="2.16.840.1.113883.5.83"/>
Treeblank.pngTreetree.pnghl7:value
PQ0 … 1R(IPS...ion)
where [@xsi:type='PQ']
 ConstraintIf Observation/value is a physical quantity (xsi:type="PQ"), the unit of measure SHALL be selected from ValueSet UnitsOfMeasureCaseSensitive 2.16.840.1.113883.1.11.12839 DYNAMIC
 Example
Result physical quantity (data type PQ): 136 mmol per liter
<value xsi:type="PQ" value="136" unit="mmol/L"/>
Treeblank.pngTreetree.pnghl7:value
IVL_PQ0 … 1R(IPS...ion)
where [@xsi:type='IVL_PQ']
 Example
Result interval of physical quantities (data type IVL_PQ): 150 - 400 Billion per 10 exp 9 liter
<value xsi:type="IVL_PQ">
  <low value="150" unit="10+9/l"/>  <high value="400" unit="10+9/l"/></value>
Treeblank.pngTreetree.pnghl7:value
ST0 … 1R(IPS...ion)
where [@xsi:type='ST']
 Example
Result free text (data type ST)
<value xsi:type="ST">This is a result as a free text</value>
Treeblank.pngTreetree.pnghl7:value
TS0 … 1R(IPS...ion)
where [@xsi:type='TS']
 Example
Result time stamp (data type TS): 6-Aug-2014
<value xsi:type="TS" value="20140806"/>
Treeblank.pngTreetree.pnghl7:value
RTO_QTY_QTY0 … 1R(IPS...ion)
where [@xsi:type='RTO_QTY_QTY']
 Example
Result ratio (data type RTO_QTY_QTY): 1/179
<value xsi:type="RTO_QTY_QTY">
  <numerator xsi:type="INT" value="1"/>  <denominator xsi:type="INT" value="179"/></value>
Treetree.pnghl7:interpretationCode
CE.IPS0 … 1R(IPS...ion)
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.78 ObservationInterpretation (DYNAMIC)
Treetree.pnghl7:target​Site​Code
CD.IPS (preferred)0 … 1(IPS...ion)
 ConstraintIf the observation site is not precoordinated in the observation/code or observation/value it SHALL be specified in the observation/targetSiteCode
 CONF
The value of @code comes preferably from value set 2.16.840.1.113883.11.22.55 IPS Body Site (DYNAMIC)
Treeblank.pngTreetree.pnghl7:qualifier
CR0 … 1Laterality(IPS...ion)
 ConstraintThe qualifier element for laterality SHALL be present if the targetSiteCode represents a paired body part and laterality is not pre-coordinated in the targetSiteCode
Treeblank.pngTreeblank.pngTreetree.pnghl7:name
CV (preferred)1 … 1M(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.png@code
CONF1 … 1F272741003
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.png@codeSystem
1 … 1F2.16.840.1.113883.6.96 (SNOMED-CT)
Treeblank.pngTreeblank.pngTreetree.pnghl7:value
CD.IPS (preferred)1 … 1M(IPS...ion)
 CONF
The value of @code comes preferably from value set 2.16.840.1.113883.11.22.57 Laterality (qualifier) (DYNAMIC)
Treeblank.pngTreetree.pnghl7:qualifier
CR0 … 1Topographical modifier(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.pnghl7:name
CV (preferred)1 … 1M(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.png@code
CONF1 … 1F106233006
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.png@codeSystem
1 … 1F2.16.840.1.113883.6.96 (SNOMED-CT)
Treeblank.pngTreeblank.pngTreetree.pnghl7:value
CD.IPS (preferred)1 … 1M(IPS...ion)
 CONF
The value of @code comes preferably from value set 2.16.840.1.113883.11.22.58 Topographical modifier (qualifier) (DYNAMIC)
Included0 … *R from 2.16.840.1.113883.10.22.4.14 IPS Body Author (DYNAMIC)
Treetree.pnghl7:author
0 … *R(IPS...ion)
Treeblank.pngTreetree.pnghl7:templateId
II1 … 1M(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.png@root
uid1 … 1F2.16.840.1.113883.10.22.4.14
Treeblank.pngTreetree.pnghl7:time
TS.IPS.TZ1 … 1R(IPS...ion)
Treeblank.pngTreetree.pnghl7:assignedAuthor
1 … 1M(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.pnghl7:id
II1 … *R(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.pnghl7:code
0 … 1R(IPS...ion)
Choice0 … 1Elements to choose from:
  • hl7:assigned​Person
  • hl7:assigned​Authoring​Device
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:assigned​Person
0 … 1C(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.png@classCode
cs0 … 1FPSN
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.png@determiner​Code
cs0 … 1FINSTANCE
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:name
PN1 … *RName of the person (e.g. the Healthcare Professional)  authoring this document(IPS...ion)
 Example<name>
  <given>John</given>  <family>Español Smith</family></name>
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:family
1 … *R(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:given
1 … *R(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:assigned​Authoring​Device
0 … 1C(IPS...ion)
 Example<assignedAuthoringDevice classCode="DEV" determinerCode="INSTANCE">
  <softwareName displayName="Turriano"/></assignedAuthoringDevice>
Included from 2.16.840.1.113883.10.22.9.2 IPS CDA Device (DYNAMIC)
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.png@classCode
cs0 … 1FDEV
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.png@determiner​Code
cs0 … 1FINSTANCE
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:code
CE0 … 1(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:manufacturer​Model​Name
SC0 … 1(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:softwareName
SC0 … 1(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.pnghl7:represented​Organization
0 … 1(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:id
II0 … *(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:name
0 … *(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:telecom
TEL0 … *(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.pnghl7:addr
AD0 … *(IPS...ion)
Treetree.pnghl7:referenceRange
0 … *R(IPS...ion)
Treeblank.pngTreetree.pnghl7:observationRange
1 … 1M(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.pnghl7:code
CDNP(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.pnghl7:value
ANY1 … 1M(IPS...ion)
Treeblank.pngTreeblank.pngTreetree.pnghl7:interpretationCode
CE0 … 1(IPS...ion)
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.png@code
CONF0 … 1FN
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.png@codeSystem
0 … 1F2.16.840.1.113883.5.83 (Observation Interpretation)
Treetree.pnghl7:entryRelationship
0 … *Contains 2.16.840.1.113883.10.22.4.22 IPS Comment Activity (DYNAMIC)(IPS...ion)
Treeblank.pngTreetree.png@typeCode
cs1 … 1FCOMP
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