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A9.2.2 Implementing each element of the HL7v2 VMR
The HL7v2 VMR OBX implementation table below defines the elements of the VMR and provides values that must be used in various OBX fields as indicated by the column headings.
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Technically, OBX for VMR Data SECTIONSECTIOHTTPAccessControlAllowOriginManagerN, STRUCTURAL and COLLECTION are optional as the structure is implied by the dotted decimal structured OBX-4 Observation sub-ID. However, including these OBX segments can be useful to viewers of the atomic data but non-essential for computed interpretation of the actual content.
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| Section Heading or Element | OBX-2 DataType | OBX-3 Value | OBX-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) | OCCURENCES | VMR DATATYPE |
|---|---|---|---|---|---|---|---|
| Report template ID | RP | 1 | HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream | 1 | ENTRY | ||
| History of Presenting Complaint | CWE | 73983-9^^LN | 1.1 | 34046-3^History of Presenting Complaint^LN | 0..1 | SECTION | |
| Chief Complaint | CWE | 10154-3^Chief Complaint^LN | 1.1.1 | Constraint (Child of Snomed-CT term 404684003 | Clinical finding (finding)) | 0..1 | CODEDVALUE | |
| Date of Onset | TS | 11368-8^Date of Onset^LN | 1.1.2 | 0..1 | DATETIME | ||
| Notes | FT | 8251-1^Notes^LN | 1.1.3 | 0..1 | STRING | ||
| History of Past Illness | CWE | 73983-9^^LN | 1.2 | 11348-0^History of Past Illness^LN^417662000^History of Past Illness^SCT | 0..1 | SECTION | |
| Past Illness† | - | 1.2.1.RepeatOf[CLUSTER -- Past Illness] | 0..* | STRUCTURAL | |||
| Past Illness | CWE | 11349-8^Past Illness^LN | 1.2.1.RepeatOf[CLUSTER -- Past Illness].1 | Constraint (Child of Snomed-CT term 404684003 | Clinical finding (finding)) | 0..1 | CODEDVALUE | |
| Temporal Context | CWE | 408731000^Temporal Context^SCT | 1.2.1.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..1 | CODEDVALUE | |
| Illness Dates | DR | 11368-8^Illness Dates^LN | 1.2.1.RepeatOf[CLUSTER -- Past Illness].3 | 0..1 | DATERANGE | ||
| Notes on Illness | FT | 8251-1^Notes on Illness^LN | 1.2.1.RepeatOf[CLUSTER -- Past Illness].4 | 0..1 | STRING | ||
| Procedures | CWE | 73983-9^^LN | 1.3 | 47519-4^^LN^416940007 | 0..1 | SECTION | |
| Procedure† | - | 71388002^Procedure^SCT | 1.3.1.RepeatOf[CLUSTER -- Procedure] | 0..* | STRUCTURAL | ||
| Procedure Performed | CWE | 29300-1^Procedure Performed^LN | 1.3.1.RepeatOf[CLUSTER -- Procedure].1 | Constraint (Child of Snomed-CT term 71388002 | Procedure (procedure) |) | Y | 0..1 | CODEDVALUE |
| Notes on Procedure | FT | 8251-1^Notes on Procedure^LN | 1.3.1.RepeatOf[CLUSTER -- Procedure].2 | 0..1 | STRING | ||
| Family History | CWE | 73983-9^^LN | 1.4 | 10157-6^Family History^LN | 0..1 | SECTION | |
| Patients Family Tree ID | ST | 74027-4^Patients Family Tree ID^LN | 1.4.1 | 0..1 | STRING | ||
| Natural Father ID | ST | 74026-6^Natural Father ID^LN | 1.4.2 | 0..1 | STRING | ||
| Natural Mother ID | ST | 74025-8^Natural Mother ID^LN | 1.4.3 | 0..1 | STRING | ||
| Relatives | CWE | 73983-9^^LN | 1.4.4 | 224086007^Relatives^SCT | 0..1 | SECTION | |
| Relative† | - | 1.4.4.1.RepeatOf[CLUSTER -- Relative] | 0..* | STRUCTURAL | |||
| Relative Name | ST | 54138-3^Relative Name^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].1 | 0..1 | STRING | ||
| Relationship | CWE | 44767-2^Relationship^LN | 1.4.4.1.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..1 | CODEDVALUE | |
| Relative ID | ST | 74024-1^Relative ID^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].3 | 0..1 | STRING | ||
| Natural Father ID | ST | 74026-6^Natural Father ID^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].4 | 0..1 | STRING | ||
| Natural Mother ID | ST | 74025-8^Natural Mother ID^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].5 | 0..1 | STRING | ||
| deceasedEstimatedAge | ST | 39016-1^Deceased Estimated Age^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].6 | 0..1 | REAL | ||
| LivingEstimatedAge | ST | 21612-7^Living Estimated Age^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].7 | 0..1 | REAL | ||
| Clinical Genomic Choice | CWE | 73983-9^^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice] | 0..* | COLLECTION | ||
| Clinical Observation | CWE | 74023-3^Clinical Observation^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].1 | 1..1 | CODEDVALUE | ||
| Negation Indicator | CWE | 74022-5^Negation Indicator^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].2 | Value Set ( 31874001^True^SCT 64100000^False^SCT 64957009^Uncertain^SCT ) | 0..1 | BOOLEAN | |
| Cause of Death | CWE | 74044-9^Cause of Death^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].3 | Value Set ( 31874001^True^SCT 64100000^False^SCT 64957009^Uncertain^SCT ) | 0..1 | BOOLEAN | |
| DataEstimatedAge | ST | 21611-9^Data Estimated Age^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].4 | 0..1 | REAL | ||
| Genetic Loci | ST | 48018-6^Genetic Loci^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].5.RepeatOf[ELEMENT -- Genetic Loci] | 0..* | STRING | ||
| Genetic Risks | CWE | 73983-9^^LN | 1.4.5 | 106221001^Genetic Risks^SCT | 0..1 | SECTION | |
| Pedigree Analysis Results † | - | 47708004^Pedigree Analysis Results^SCT | 1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results] | 0..* | STRUCTURAL | ||
| Genetic Disease Assessed | CWE | 51967-8^Genetic Disease Assessed^LN | 1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].1 | 0..1 | CODEDVALUE | ||
| Input Parameters | CWE | 73983-9^^LN | 1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2 | 73983-9^Input Parameters^LN | 0..1 | SECTION | |
| Genetic Algorithm Used | CWE | 74021-7^Genetic Algorithm Used^LN | 1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2.1 | 0..1 | CODEDVALUE | ||
| Sensitivity | NM | 74020-9^Sensitivity^LN | 1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2.2 | 0..1 | PHYSICALQUANTITY | ||
| Probability of Disease | ST | 74019-1^Probability of Disease^LN | 1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].3.RepeatOf[ELEMENT -- Probability of Disease] | 0..* | REAL | ||
| Pregnancy History | CWE | 73983-9^^LN | 1.5 | 11449-6^Pregnancy History^LN | 0..1 | SECTION | |
| Gravida | NM | 11996-6^Gravida^LN | 1.5.1 | 0..1 | INTEGER | ||
| Parity | NM | 11977-6^Parity^LN | 1.5.2 | 0..1 | INTEGER | ||
| Miscarriages | NM | 11614-5^Miscarriages^LN | 1.5.3 | 0..1 | INTEGER | ||
| Terminations | NM | 11613-7^Terminations^LN | 1.5.4 | 0..1 | INTEGER | ||
| Social History | CWE | 73983-9^^LN | 1.6 | 29762-2^Social History^LN | 0..1 | SECTION | |
| Social Situation | FT | 10166-7^Social Situation^LN | 1.6.1 | 0..1 | STRING | ||
| Substance Use | CWE | 73983-9^^LN | 1.7 | 18663-5^Substance Use^LN | 0..1 | SECTION | |
| Smoking History | CWE | 73983-9^^LN | 1.7.1 | 11367-0^Smoking History^LN | 0..1 | SECTION | |
| Tobacco use and exposure | CWE | 63638-1^Tobacco use and exposure^LN | 1.7.1.1 | Value Set ( 8517006^Ex-smoker^SCT 43381005^Passive smoker^SCT 77176002^Smoker^SCT 8392000^Non-smoker^SCT ) | 0..1 | CODEDVALUE | |
| Tobacco smoking consumption | NM | 63858-5^Tobacco smoking consumption^LN | 1.7.1.2 | 0..1 | PHYSICALQUANTITY | ||
| Lifetime Intake | NM | 74011-8^Lifetime Intake^LN | 1.7.1.3 | 0..1 | PHYSICALQUANTITY | ||
| Date Ceased | DT | 74010-0^Date Ceased^LN | 1.7.1.4 | 0..1 | DATETIME | ||
| Alcohol Intake | CWE | 73983-9^^LN | 1.7.2 | 11330-8^Alcohol Intake^LN | 0..1 | SECTION | |
| Alcohol Intake | CWE | 11331-6^Alcohol Intake^LN | 1.7.2.1 | Value Set ( 82581004^Ex-drinker^SCT 105542008^Non - drinker^SCT 219006^Current drinker^SCT ) | 0..1 | CODEDVALUE | |
| Last Drank Alcohol | DT | 74014-2^Last Drank Alcohol^LN | 1.7.2.2 | 0..1 | DATETIME | ||
| 30 day quantity and frequency | CWE | 73983-9^^LN | 1.7.2.3 | 030301^30 day quantity and frequency^PHENX | 0..1 | SECTION | |
| Number of days alcohol consumed | NM | 63597-9^Number of days alcohol consumed^LN | 1.7.2.3.1 | 0..1 | INTEGER | ||
| Standard drinks per day on a drinking day in last 30 days | NM | 63598-7^Standard drinks per day on a drinking day in last 30 days^LN | 1.7.2.3.2 | 0..1 | INTEGER | ||
| Average Daily Alcohol Intake | NM | 74013-4^Average Daily Alcohol Intake^LN | 1.7.2.4 | 0..1 | PHYSICALQUANTITY | ||
| Maximum Daily Standard Drinks | NM | 63591-2^Maximum Daily Standard Drinks^LN | 1.7.2.5 | 0..1 | PHYSICALQUANTITY | ||
| Years Alcohol Consumed | NM | 74012-6^Years Alcohol Consumed^LN | 1.7.2.6 | 0..1 | PHYSICALQUANTITY | ||
| Alcohol abuse or dependence (eg e.g. DSM IV) | CWE | 74043-1^Alcohol abuse or dependence (eg e.g. DSM IV)^LN | 1.7.2.7 | Value Set ( 31874001^True^SCT 64100000^False^SCT 64957009^Uncertain^SCT ) | 0..1 | BOOLEAN | |
| Other substance Use | CWE | 73983-9^^LN | 1.7.3 | 11342-3^Other substance Use^LN | 0..1 | SECTION | |
| Drug misuse details | CWE | 228366006^Drug misuse details^SCT | 1.7.3.1.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 History | CWE | 73983-9^^LN | 1.8 | 266930008^Exercise History^SCT | 0..1 | SECTION | |
| Currently Exercising | CWE | 74008-4^Exercise intensity^LN^Exercise intensity^LN | 1.8.1 | 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..1 | CODEDVALUE | |
| Exercise Type | CWE | 55410-5^Exercise Type^LN | 1.8.2 | Value Set ( 229072005^Aerobic^SCT ) | 0..1 | CODEDVALUE | |
| Time Spent Exercising | NM | 74009-2^Time Spent Exercising^LN | 1.8.3 | 0..1 | PHYSICALQUANTITY | ||
| Vitals | CWE | 73983-9^^LN | 1.9 | 8716-3^Vitals^LN | 0..1 | SECTION | |
| Blood Pressure | CWE | 73983-9^^LN | 1.9.1.RepeatOf[CLUSTER -- Blood Pressure] | 55417-0^Blood Pressure^LN | 0..* | COLLECTION | |
| Systolic Pressure | NM | 8480-6^Systolic Pressure^LN | 1.9.1.RepeatOf[CLUSTER -- Blood Pressure].1 | Y | 0..1 | PHYSICALQUANTITY | |
| Diastolic Pressure | NM | 8462-4^Diastolic Pressure^LN | 1.9.1.RepeatOf[CLUSTER -- Blood Pressure].2 | 0..1 | PHYSICALQUANTITY | ||
| Patient Position | CWE | 8361-8^Patient Position^LN | 1.9.1.RepeatOf[CLUSTER -- Blood Pressure].3 | Value Set ( 33586001^Sitting^SCT 102538003^Lying^SCT 272580008^Semi-recumbent^SCT 10904000^Standing^SCT ) | 0..1 | CODEDVALUE | |
| Pulse rate | NM | 8893-0^Pulse rate^LN | 1.9.2.RepeatOf[ELEMENT -- Pulse rate] | Y | 0..* | PHYSICALQUANTITY | |
| Weight | NM | 29463-7^Weight^LN | 1.9.3.RepeatOf[ELEMENT -- Weight] | Y | 0..* | PHYSICALQUANTITY | |
| BMI | NM | 39156-5^BMI^LN | 1.9.4.RepeatOf[ELEMENT -- BMI] | Y | 0..* | PHYSICALQUANTITY | |
| Oxygen Saturation | NM | 59408-5^Oxygen Saturation^LN | 1.9.5.RepeatOf[ELEMENT -- Oxygen Saturation] | Y | 0..* | PHYSICALQUANTITY | |
| Height | NM | 8302-2^Height^LN | 1.9.6.RepeatOf[ELEMENT -- Height] | Y | 0..* | PHYSICALQUANTITY | |
| Temperature | NM | 8310-5^Temperature^LN | 1.9.7.RepeatOf[ELEMENT -- Temperature] | Y | 0..* | PHYSICALQUANTITY | |
| Respiratory rate | NM | 9279-1^Respiratory rate^LN | 1.9.8.RepeatOf[ELEMENT -- Respiratory rate] | 0..* | PHYSICALQUANTITY | ||
| Alerts | CWE | 73983-9^^LN | 1.10 | 44944-7^Alerts^LN | 0..1 | SECTION | |
| Alert | - | 1.10.1.RepeatOf[CLUSTER -- Alert] | 0..* | STRUCTURAL | |||
| Alert Type | CWE | 74018-3^Alert Type^LN | 1.10.1.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..1 | CODEDVALUE | |
| Active | CWE | 74017-5^Active^LN | 1.10.1.RepeatOf[CLUSTER -- Alert].2 | Value Set ( 31874001^True^SCT 64100000^False^SCT 64957009^Uncertain^SCT ) | 0..1 | BOOLEAN | |
| Specific Alert | CWE | 44944-7^Specific Alert^LN | 1.10.1.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..1 | CODEDVALUE | |
| Reported by | CWE | 48766-0^Reported by^LN | 1.10.1.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..1 | CODEDVALUE | |
| Recorded date | DT | 74015-9^Recorded date^LN | 1.10.1.RepeatOf[CLUSTER -- Alert].5 | 0..1 | DATETIME |
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Each OBX must have it's OBX-2 value as specified exactly as per the HL7v2 VMR OBX implementation table.
A9.2.2.3 OBX-3 Observation Identifier (CE)
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By example consider the history of past illness from the above table. Here is the subset for convenience.
| Section Heading or Element | OBX-2 DataType | OBX-3 Value | OBX-4 Observation sub-ID | OCCURENCES | VMR DATATYPE |
|---|---|---|---|---|---|
| History of Past Illness | CWE | 73983-9^^LN | 1.2 | 0..1 | SECTION |
| Past Illness† | - | 1.2.1.RepeatOf[CLUSTER -- Past Illness] | 0..* | STRUCTURAL | |
| Past Illness | CWE | 11349-8^Past Illness^LN | 1.2.1.RepeatOf[CLUSTER -- Past Illness].1 | 0..1 | CODEDVALUE |
For items in the table with occurrences with an upper bound > 1 (eg e.g. 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 must be prefixed with this sub-ID value.
For example, the first instance of a past illness the OBX-4 sub-ID must be 1.2.1.1, for the second 1.2.1.2.
Based on this the Past Illness OBXes for the first illness 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 must be 1.2.1.2.1.
| Code Block | ||
|---|---|---|
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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 Element | OBX-2 DataType | OBX-3 Value | OBX-4 Observation sub-ID | OCCURENCES | VMR DATATYPE |
|---|---|---|---|---|---|
| Relatives | CWE | 73983-9^^LN | 1.4.4 | 0..1 | SECTION |
| Relative† | - | 1.4.4.1.RepeatOf[CLUSTER -- Relative] | 0..* | STRUCTURAL | |
| ... | |||||
| Clinical Genomic Choice | CWE | 73983-9^^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice] | 0..* | COLLECTION |
| Clinical Observation | CWE | 74023-3^Clinical Observation^LN | 1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].1 | 1..1 | CODEDVALUE |
| Genetic Loci | ST | 48018-6^Genetic Loci^LN | 1.4.4.1.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
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