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Table of Contents

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When using the HL7v2 VMR a header OBX must be present which indicates that a report template is in use. In the header, OBX-3 field must have the value "74028-2^Report template ID^LN", and the template that is in use OBX-5 must, and also specify an OBX-4 sub-ID which must be a dotted decimal value (for simplicity "1" has been specified as the root sub ID). This header OBX should must have a OBX-2 Datatype field value of "RP" (See 3.20 RP - Reference Pointer). OBX-5 must be valued as "HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream".

...

The Appendix 9 HL7v2 Virtual Medical Record below defines the elements of the VMR and provides values that must be used in various OBX fields as indicated by the column headings. 

Each VMR element should must be implemented as an OBX, the values of which will be discussed following the table.

...

Section Heading or ElementOBX-2 DataTypeOBX-3 ValueOBX-4 Observation sub-ID

Suggested

OBX-5 Observation value

or

Value Set or Constraint

OBX-14 Date/time of the observation is valued

(Y=Yes, N=No)

OCCURENCESVMR DATATYPE
Report template IDRP 1HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream 1ENTRY
History of Presenting ComplaintCWE73983-9^^LN1.134046-3^History of Presenting Complaint^LN 0..1SECTION
Chief ComplaintCWE10154-3^Chief Complaint^LN1.1.1Constraint (Child of Snomed-CT term 404684003 | Clinical finding (finding)) 0..1CODEDVALUE
Date of OnsetTS11368-8^Date of Onset^LN1.1.2  0..1DATETIME
NotesFT8251-1^Notes^LN1.1.3  0..1STRING
History of Past IllnessCWE73983-9^^LN1.211348-0^History of Past Illness^LN^417662000^History of Past Illness^SCT 0..1SECTION
Past Illness†- 1.2.1.RepeatOf[CLUSTER -- Past Illness]  0..*STRUCTURAL
Past IllnessCWE11349-8^Past Illness^LN1.2.1.RepeatOf[CLUSTER -- Past Illness].1Constraint (Child of Snomed-CT term 404684003 | Clinical finding (finding)) 0..1CODEDVALUE
Temporal ContextCWE408731000^Temporal Context^SCT1.2.1.RepeatOf[CLUSTER -- Past Illness].2

Value Set (

15240007^Current^SCT

410511007^Current or past^SCT

410587003^Past - specified^SCT

410588008^Past - unspecified^SCT

410589000^All times past^SCT

6493001^Recent^SCT

)

 

If the temporal context is unspecified, then 410511007^Current or past^SCT is the assumed value.

 0..1CODEDVALUE
Illness DatesDR11368-8^Illness Dates^LN1.2.1.RepeatOf[CLUSTER -- Past Illness].3  0..1DATERANGE
Notes on IllnessFT8251-1^Notes on Illness^LN1.2.1.RepeatOf[CLUSTER -- Past Illness].4  0..1STRING
ProceduresCWE73983-9^^LN1.347519-4^^LN^416940007 0..1SECTION
Procedure†-71388002^Procedure^SCT1.3.1.RepeatOf[CLUSTER -- Procedure]  0..*STRUCTURAL
Procedure PerformedCWE29300-1^Procedure Performed^LN1.3.1.RepeatOf[CLUSTER -- Procedure].1Constraint (Child of Snomed-CT term 71388002 | Procedure (procedure) |)Y0..1CODEDVALUE
Notes on ProcedureFT8251-1^Notes on Procedure^LN1.3.1.RepeatOf[CLUSTER -- Procedure].2  0..1STRING
Family HistoryCWE73983-9^^LN1.410157-6^Family History^LN 0..1SECTION
Patients Family Tree IDST74027-4^Patients Family Tree ID^LN1.4.1  0..1STRING
Natural Father IDST74026-6^Natural Father ID^LN1.4.2  0..1STRING
Natural Mother IDST74025-8^Natural Mother ID^LN1.4.3  0..1STRING
RelativesCWE73983-9^^LN1.4.4224086007^Relatives^SCT 0..1SECTION
Relative†- 1.4.4.1.RepeatOf[CLUSTER -- Relative]  0..*STRUCTURAL
Relative NameST54138-3^Relative Name^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].1  0..1STRING
RelationshipCWE44767-2^Relationship^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].2

Constraint (HL7 v3 FamilyMember Value set = Child of Role Code _PersonalRelationshipRoleType FAMMEMB)

Use "ROLECODE" for Name of Coding System component of CWE

See Table HL7 v3 FamilyMember Value set below

 0..1CODEDVALUE
Relative IDST74024-1^Relative ID^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].3  0..1STRING
Natural Father IDST74026-6^Natural Father ID^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].4  0..1STRING
Natural Mother IDST74025-8^Natural Mother ID^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].5  0..1STRING
deceasedEstimatedAgeST39016-1^Deceased Estimated Age^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].6  0..1REAL
LivingEstimatedAgeST21612-7^Living Estimated Age^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].7  0..1REAL
Clinical Genomic ChoiceCWE73983-9^^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice]  0..*COLLECTION
Clinical ObservationCWE74023-3^Clinical Observation^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].1  1..1CODEDVALUE
Negation IndicatorCWE74022-5^Negation Indicator^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].2

Value Set (

31874001^True^SCT

64100000^False^SCT

64957009^Uncertain^SCT

)

 0..1BOOLEAN
Cause of DeathCWE74044-9^Cause of Death^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].3

Value Set (

31874001^True^SCT

64100000^False^SCT

64957009^Uncertain^SCT

)

 0..1BOOLEAN
DataEstimatedAgeST21611-9^Data Estimated Age^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].4  0..1REAL
Genetic LociST48018-6^Genetic Loci^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].5.RepeatOf[ELEMENT -- Genetic Loci]  0..*STRING
Genetic RisksCWE73983-9^^LN1.4.5106221001^Genetic Risks^SCT 0..1SECTION
Pedigree Analysis Results †-47708004^Pedigree Analysis Results^SCT1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results]  0..*STRUCTURAL
Genetic Disease AssessedCWE51967-8^Genetic Disease Assessed^LN1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].1  0..1CODEDVALUE
Input ParametersCWE73983-9^^LN1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].273983-9^Input Parameters^LN 0..1SECTION
Genetic Algorithm UsedCWE74021-7^Genetic Algorithm Used^LN1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2.1  0..1CODEDVALUE
SensitivityNM74020-9^Sensitivity^LN1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2.2  0..1PHYSICALQUANTITY
Probability of DiseaseST74019-1^Probability of Disease^LN1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].3.RepeatOf[ELEMENT -- Probability of Disease]  0..*REAL
Pregnancy HistoryCWE73983-9^^LN1.511449-6^Pregnancy History^LN 0..1SECTION
GravidaNM11996-6^Gravida^LN1.5.1  0..1INTEGER
ParityNM11977-6^Parity^LN1.5.2  0..1INTEGER
MiscarriagesNM11614-5^Miscarriages^LN1.5.3  0..1INTEGER
TerminationsNM11613-7^Terminations^LN1.5.4  0..1INTEGER
Social HistoryCWE73983-9^^LN1.629762-2^Social History^LN 0..1SECTION
Social SituationFT10166-7^Social Situation^LN1.6.1  0..1STRING
Substance UseCWE73983-9^^LN1.718663-5^Substance Use^LN 0..1SECTION
Smoking HistoryCWE73983-9^^LN1.7.111367-0^Smoking History^LN 0..1SECTION
Tobacco use and exposureCWE63638-1^Tobacco use and exposure^LN1.7.1.1

Value Set (

8517006^Ex-smoker^SCT

 43381005^Passive smoker^SCT

77176002^Smoker^SCT

8392000^Non-smoker^SCT

)

 0..1CODEDVALUE
Tobacco smoking consumptionNM63858-5^Tobacco smoking consumption^LN1.7.1.2  0..1PHYSICALQUANTITY
Lifetime IntakeNM74011-8^Lifetime Intake^LN1.7.1.3  0..1PHYSICALQUANTITY
Date CeasedDT74010-0^Date Ceased^LN1.7.1.4  0..1DATETIME
Alcohol IntakeCWE73983-9^^LN1.7.211330-8^Alcohol Intake^LN 0..1SECTION
Alcohol IntakeCWE11331-6^Alcohol Intake^LN1.7.2.1

Value Set (

82581004^Ex-drinker^SCT

105542008^Non - drinker^SCT

219006^Current drinker^SCT

)

 0..1CODEDVALUE
Last Drank AlcoholDT74014-2^Last Drank Alcohol^LN1.7.2.2  0..1DATETIME
30 day quantity and frequencyCWE73983-9^^LN1.7.2.3030301^30 day quantity and frequency^PHENX 0..1SECTION
Number of days alcohol consumedNM63597-9^Number of days alcohol consumed^LN1.7.2.3.1  0..1INTEGER
Standard drinks per day on a drinking day in last 30 daysNM63598-7^Standard drinks per day on a drinking day in last 30 days^LN1.7.2.3.2  0..1INTEGER
Average Daily Alcohol IntakeNM74013-4^Average Daily Alcohol Intake^LN1.7.2.4  0..1PHYSICALQUANTITY
Maximum Daily Standard DrinksNM63591-2^Maximum Daily Standard Drinks^LN1.7.2.5  0..1PHYSICALQUANTITY
Years Alcohol ConsumedNM74012-6^Years Alcohol Consumed^LN1.7.2.6  0..1PHYSICALQUANTITY
Alcohol abuse or dependence (eg DSM IV)CWE74043-1^Alcohol abuse or dependence (eg DSM IV)^LN1.7.2.7

Value Set (

31874001^True^SCT

64100000^False^SCT

64957009^Uncertain^SCT

)

 0..1BOOLEAN
Other substance UseCWE73983-9^^LN1.7.311342-3^Other substance Use^LN 0..1SECTION
Drug misuse detailsCWE228366006^Drug misuse details^SCT1.7.3.1.RepeatOf[ELEMENT -- Drug misuse details]

Value Set (

428659002^Amphetamine misuse^SCT

429179002^Antidepressant misuse^SCT

428623008^Barbiturate misuse^SCT

428823006^Cannabis misuse^SCT

429782000^Cocaine misuse^SCT

307052004^Illicit drug use^SCT

228376009^Inhales drugs^SCT

226034001^Injecting drug user^SCT

70545002^Narcotic drug user^SCT

105546006^Occasional drug abuser^SCT

228372006^Poly-drug misuser^SCT

428495004^Solvent misuse^SCT

228381000^Sniffs drugs^SCT

429512006^Methadone misuse^SCT

)

 0..*CODEDVALUE
Exercise HistoryCWE73983-9^^LN1.8266930008^Exercise History^SCT 0..1SECTION
Currently ExercisingCWE74008-4^Exercise intensity^LN1.8.1

Value Set (

 160635005^Exercise grading unknown^SCT

160633003^Enjoys heavy exercise^SCT

160645007^Enjoys intermediate exercise^SCT

228446001^Gets little exercise^SCT

228445002^Gets no exercise^SCT

160631001^Enjoys light exercise^SCT

160632008^Enjoys moderate exercise^SCT

102533007^Excessive exercise^SCT

)

 0..1CODEDVALUE
Exercise TypeCWE55410-5^Exercise Type^LN1.8.2

Value Set (

229072005^Aerobic^SCT

)

 0..1CODEDVALUE
Time Spent ExercisingNM74009-2^Time Spent Exercising^LN1.8.3  0..1PHYSICALQUANTITY
VitalsCWE73983-9^^LN1.98716-3^Vitals^LN 0..1SECTION
Blood PressureCWE73983-9^^LN1.9.1.RepeatOf[CLUSTER -- Blood Pressure]55417-0^Blood Pressure^LN 0..*COLLECTION
Systolic PressureNM8480-6^Systolic Pressure^LN1.9.1.RepeatOf[CLUSTER -- Blood Pressure].1 Y0..1PHYSICALQUANTITY
Diastolic PressureNM8462-4^Diastolic Pressure^LN1.9.1.RepeatOf[CLUSTER -- Blood Pressure].2  0..1PHYSICALQUANTITY
Patient PositionCWE8361-8^Patient Position^LN1.9.1.RepeatOf[CLUSTER -- Blood Pressure].3

Value Set (

33586001^Sitting^SCT

102538003^Lying^SCT

272580008^Semi-recumbent^SCT

10904000^Standing^SCT

)

 0..1CODEDVALUE
Pulse rateNM8893-0^Pulse rate^LN1.9.2.RepeatOf[ELEMENT -- Pulse rate] Y0..*PHYSICALQUANTITY
WeightNM29463-7^Weight^LN1.9.3.RepeatOf[ELEMENT -- Weight] Y0..*PHYSICALQUANTITY
BMINM39156-5^BMI^LN1.9.4.RepeatOf[ELEMENT -- BMI] Y0..*PHYSICALQUANTITY
Oxygen SaturationNM59408-5^Oxygen Saturation^LN1.9.5.RepeatOf[ELEMENT -- Oxygen Saturation] Y0..*PHYSICALQUANTITY
HeightNM8302-2^Height^LN1.9.6.RepeatOf[ELEMENT -- Height] Y0..*PHYSICALQUANTITY
TemperatureNM8310-5^Temperature^LN1.9.7.RepeatOf[ELEMENT -- Temperature] Y0..*PHYSICALQUANTITY
Respiratory rateNM9279-1^Respiratory rate^LN1.9.8.RepeatOf[ELEMENT -- Respiratory rate]  0..*PHYSICALQUANTITY
AlertsCWE73983-9^^LN1.1044944-7^Alerts^LN 0..1SECTION
Alert - 1.10.1.RepeatOf[CLUSTER -- Alert]  0..*STRUCTURAL
Alert TypeCWE74018-3^Alert Type^LN1.10.1.RepeatOf[CLUSTER -- Alert].1

Value Set (

129697009^Psychosocial^SCT

307824009^Administrative^SCT

281694009^Clinical^SCT

102487004^Environmental^SCT

78648007^Infection risk^SCT

405145004^Safety and security^SCT

363871006^Special Mental Health^SCT

315638005^Special needs and/or preferences^SCT

)

 0..1CODEDVALUE
ActiveCWE74017-5^Active^LN1.10.1.RepeatOf[CLUSTER -- Alert].2

Value Set (

31874001^True^SCT

64100000^False^SCT

64957009^Uncertain^SCT

)

 0..1BOOLEAN
Specific AlertCWE44944-7^Specific Alert^LN1.10.1.RepeatOf[CLUSTER -- Alert].3

Suggested Value Set (

40739000^Has difficulty swallowing^SCT

224331001^Known to police^SCT

224347004^Has enduring power of attorney^SCT

310301000^Has advance health directive^SCT

)

 0..1CODEDVALUE
Reported byCWE48766-0^Reported by^LN1.10.1.RepeatOf[CLUSTER -- Alert].4

Value Set (

116154003^Subject of care^SCT

229774002^Carer^SCT

223366009^Health worker^SCT

307982007^Social services provider^SCT

14406004^Police^SCT

303071001^Family member^SCT

113163005^Friend^SCT

)

 0..1CODEDVALUE
Recorded dateDT74015-9^Recorded date^LN1.10.1.RepeatOf[CLUSTER -- Alert].5  0..1DATETIME

...

In the table Appendix 9 HL7v2 Virtual Medical Record OBX-4 subIDs are dotted decimals that start with "1" which is the root OBX-4 subID for all elements of the HL7v2 Virtual Medical Record. The root value "1" has been specified in the above table to aid in simplicity. Theoretically other subID root values could be used instead of "1", but this value should must be practical in most cases.

Observations which are not specified by the HL7v2 VMR should must not have a OBX-4 subID sharing the same root.

Rows marked VMR DATATYPE column as STRUCTURAL (red rows) should must not be written to OBX segments and are present in the table are purely virtual and are to assist with understanding the hierarchy. They should must be allocated a dotted subID however, on which all child elements should must be prefixed with this subID. 

...

By example consider the history of past illness from the above table. Here is the subset for convenience.

Section Heading or ElementOBX-2 DataTypeOBX-3 ValueOBX-4 Observation sub-IDOCCURENCESVMR DATATYPE
History of Past IllnessCWE73983-9^^LN1.20..1SECTION
Past Illness†- 1.2.1.RepeatOf[CLUSTER -- Past Illness]0..*STRUCTURAL
Past IllnessCWE11349-8^Past Illness^LN1.2.1.RepeatOf[CLUSTER -- Past Illness].10..1CODEDVALUE

For items in the table with occurrences with an upper bound > 1 (eg 0..*) that element will have "RepeatOf[]"  specified in the OBX-4 Observation sub-ID. The "RepeatOf[]" must be substituted with the repeat index integer of the element/structural/section group. All child elements for the repeat index should must be prefixed with this sub-ID value.

For example, the first instance of a past illness the OBX-4 sub-ID should must be 1.2.1.1, for the second 1.2.1.2.

Based on this the Past Illness OBXes for the first illness should must have a OBX-4 sub-ID value of 1.2.1.1.1, and for the second illness, the OBX-4 sub-ID value should must be 1.2.1.2.1.

 

Code Block
titleExample of OBX segments with subIDs indicating 2 past illnesses
OBX|6|CE|70949-3^^LN|1.2|11348-0^History of Past Illness^LN^417662000^History of Past Illness^SCT||||||F
OBX|7|CE|11349-8^Past Illness^LN|1.2.1.1.1|50711007^Viral hepatitis C^SCT||||||F
OBX|8|CE|408731000^Temporal Context^SCT|1.2.1.1.2|410584005^Current - specified^SCT||||||F
OBX|9|DR|11368-8^Illness Dates^LN|1.2.1.1.3|20090107||||||F
OBX|10|CE|11349-8^Past Illness^LN|1.2.1.2.1|6142004^Influenza^SCT||||||F
OBX|11|CE|408731000^Temporal Context^SCT|1.2.1.2.2|410587003^Past - specified^SCT||||||F
OBX|12|DR|11368-8^Illness Dates^LN|1.2.1.2.3|20170131^20170318||||||F

OBXs with OBX-1 Set ID of 7,8,9 are part of the first illness as their OBX-4 subID is prefixed with 1.2.1.1.

OBX  with OBX-1 Set ID 10,11,12 are part of the second illness as their OBX-4 subID is prefixed with 1.2.1.2.

A9.2.3.4.2 Use of complex OBX-4 with multiple nested repeating elements

Structures may repeat at multiple levels. A complex example is the Genetic Loci element which may have many 0.* for each of the repeating Clinical Genomic Choice collection (0...*) for each relative. For convenience see the subset of the table here:

Section Heading or ElementOBX-2 DataTypeOBX-3 ValueOBX-4 Observation sub-IDOCCURENCESVMR DATATYPE
RelativesCWE73983-9^^LN1.4.40..1SECTION
Relative†- 1.4.4.1.RepeatOf[CLUSTER -- Relative]0..*STRUCTURAL
...     
Clinical Genomic ChoiceCWE73983-9^^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice]0..*COLLECTION
Clinical ObservationCWE74023-3^Clinical Observation^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].11..1CODEDVALUE
Genetic LociST48018-6^Genetic Loci^LN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].5.RepeatOf[ELEMENT -- Genetic Loci]0..*STRING

As an example the OBX-4 sub-ID value for the fourth Genetic Loci for the second relative's third clinical genomic choice would be (note the variable parts of the sub-ID are indicated bold): 1.4.4.1.2.8.3.5.4

...

OBX-5 value domains in table Appendix 9 HL7v2 Virtual Medical Record are suggested and values only, sending systems should must use the values that they have available in their systems. If common standard terminologies are available, then those can be supplied as alternative code components of the CE/CWE/CNE if a standard terminology isn't used aren't the primary coding system. Where no codes is available then only the text component should must be populated.

 

A9.3 Value Domain Tables

...