Template  OBX - Observation/Result

This field contains the format of the observation value in OBX. It must be valued if OBX-11-Observ result status is not valued with an "X". If the value is CE then the result must be a coded entry. When the value type is TX or FT then the results are bulk text. The valid values for the value type of an observation are listed in HL7 Table 0125 - Value Type.

The observation value must be represented according to the format for the data type defined in Chapter 2, Section 2.9, “Data Types.” For example, a PN consists of 6 components, separated by component delimiters.

Although NM is a valid type, observations which are usually reported as numbers will sometimes have the string (ST) data type because non-numeric characters are often reported as part of the result, e.g., >300 to indicate the result was off-scale for the instrument. In the example, ">300", ">" is a symbol and the digits are considered a numeric value. However, this usage of the ST type should be discouraged since the SN (structured numeric) data type now accommodates such reporting and, in addition, permits the receiving system to interpret the magnitude.

All HL7 data types are valid, and are included in Table 0125 except CM, CQ, SI, and ID. For a CM definition to have meaning, the specifics about the CM must be included in the field definition. OBX-5-observation value is a general field definition that is influenced by the data type OBX-3, so CMs are undefined in this context. CQ is invalid because units for OBX-5-observation value are always specified explicitly in an OBX segment with OBX-6 units. SI is invalid because it only applied to HL7 message segments, and ID because it requires a constant field definition.

The RP value (reference pointer) must be used if the actual observation value is not sent in OBX but exists somewhere else. For example, if the observation consists of an image (document or medical), the image itself cannot be sent in OBX. The sending system may in that case opt to send a reference pointer. The receiving system can use this reference pointer whenever it needs access to the actual image through other interface standards, e.g., DICOM, or through appropriate data base servers.

The full definition of these data types is given in Chapter 2, Section 2.9, “Data Types.” The structured numeric (SN) data type, new to version 2.3, provides for reporting ranges (e.g., 3-5 or 10-20), titres (e.g., 1:10), and out-of-range indicators (e.g., >50) in a structured and computer interpretable way.

We allow the FT data type in the OBX segment but its use is discouraged. Formatted text usually implies a meaningful structure e.g., a list of three independent diagnoses reported on different lines. But ideally, the structure in three independent diagnostic statements would be reported as three separate OBX segments.

TX should not be used except to send large amounts of text. In the TX data type, the repeat delimiter can only be used to identify paragraph breaks. Use ST to send short, and possibly encodable, text strings.

CDA documents are to be exchanged in the OBX segment in any message that can exchange documents (such as MDM or ORU). Within the OBX segment, the MIME package is encoded as an encapsulated (ED) data type.

This field contains a unique identifier for the observation. The format is that of the Coded Element (CE).

In most systems the identifier will point to a master observation table that will provide other attributes of the observation that may be used by the receiving system to process the observations it receives. A set of message segments for transmitting such master observation tables is described in Chapter 8. The relation of an observation ID to a master observation table is analogous to the relationship between a charge code (in a billing record) and the charge master.

When local codes are used as the first identifier in this field we strongly encourage sending a universal identifier as well to permit receivers to equivalence results from different providers of the same service (e.g., a hospital lab and commercial lab that provides serum potassium to a nursing home). LOINC® is an HL7 approved code system for the Observation identifier. It covers observations and measurements, such as laboratory tests, physical findings, radiology studies, and claims attachments and can be obtained from www.regenstrief.org/loinc/loinc.htm. One possible universal identifier is LOINC® codes for laboratory and clinical measurements (see HL7 defined Table 0396 and the HL7 www list server) and Appendix X2 of ASTM E1467 for neurophysiology tests.

For a discussion of the use of suffixes as related to narrative reports see Section 7.2.3 and Section 7.2.4.