Swissnoso Implementation Guide (R4)
1.0.0 - STU 1 Switzerland flag

This page is part of the Swissnoso Implementation Guide (R4) (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: Swissnoso Observation Angle Pain or Tenderness

Official URL: http://fhir.ch/ig/swissnoso/StructureDefinition/swissnoso-observation-angle-pain-or-tenderness Version: 1.0.0
Active as of 2022-06-14 Computable Name: SwissnosoObservationAnglePainOrTenderness

Copyright/Legal: CC-BY-SA-4.0

This profile constrains the Observation resource to represent the presence/absence of the symptom costovertebral angle pain or tenderness in the context of the CAUTI Surveillance module.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from SwissnosoObservation

Summary

Mandatory: 2 elements

Slices

This structure defines the following Slices:

  • The element Observation.value[x] is sliced based on the value of type:$this

This structure is derived from SwissnosoObservation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*SwissnosoObservationSwissnoso Observation Angle Pain or Tenderness
swissnoso-obs-2: If this symptom exists (valueBoolean = true), then a date must be specified
... code 1..1CodeableConceptCostovertebral angle pain or tenderness
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://fhir.ch/ig/swissnoso/CodeSystem/swissnoso-clinical-symptom
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 3
... effectiveDateTime 0..1dateTimeDate of symptom onset
... value[x] 1..1booleanActual result
Slice: Unordered, Open by type:$this

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*SwissnosoObservationSwissnoso Observation Angle Pain or Tenderness
swissnoso-obs-2: If this symptom exists (valueBoolean = true), then a date must be specified
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... category 0..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


... code Σ1..1CodeableConceptCostovertebral angle pain or tenderness
Binding: LOINCCodes (example): Codes identifying names of simple observations.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://fhir.ch/ig/swissnoso/CodeSystem/swissnoso-clinical-symptom
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 3
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject Σ1..1Reference(Swissnoso Patient)Who and/or what the observation is about
... focus Σ0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ1..1Reference(Swissnoso Encounter)Healthcare event during which this observation is made
... Slices for effective[x] Σ0..1dateTimeClinically relevant time/time-period for observation
Slice: Unordered, Closed by type:$this
.... effective[x]:effectiveDateTime Σ0..1dateTimeDate of symptom onset
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... Slices for value[x] ΣI1..1booleanActual result
Slice: Unordered, Closed by type:$this
.... value[x]:valueBoolean ΣI1..1booleanCostovertebral angle pain or tenderness (yes/no)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component Σ0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.

.... value[x] Σ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*SwissnosoObservationSwissnoso Observation Angle Pain or Tenderness
swissnoso-obs-2: If this symptom exists (valueBoolean = true), then a date must be specified

doco Documentation for this format

This structure is derived from SwissnosoObservation

Summary

Mandatory: 2 elements

Slices

This structure defines the following Slices:

  • The element Observation.value[x] is sliced based on the value of type:$this

Differential View

This structure is derived from SwissnosoObservation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*SwissnosoObservationSwissnoso Observation Angle Pain or Tenderness
swissnoso-obs-2: If this symptom exists (valueBoolean = true), then a date must be specified
... code 1..1CodeableConceptCostovertebral angle pain or tenderness
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://fhir.ch/ig/swissnoso/CodeSystem/swissnoso-clinical-symptom
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 3
... effectiveDateTime 0..1dateTimeDate of symptom onset
... value[x] 1..1booleanActual result
Slice: Unordered, Open by type:$this

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*SwissnosoObservationSwissnoso Observation Angle Pain or Tenderness
swissnoso-obs-2: If this symptom exists (valueBoolean = true), then a date must be specified
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.

... category 0..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


... code Σ1..1CodeableConceptCostovertebral angle pain or tenderness
Binding: LOINCCodes (example): Codes identifying names of simple observations.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://fhir.ch/ig/swissnoso/CodeSystem/swissnoso-clinical-symptom
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 3
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject Σ1..1Reference(Swissnoso Patient)Who and/or what the observation is about
... focus Σ0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ1..1Reference(Swissnoso Encounter)Healthcare event during which this observation is made
... Slices for effective[x] Σ0..1dateTimeClinically relevant time/time-period for observation
Slice: Unordered, Closed by type:$this
.... effective[x]:effectiveDateTime Σ0..1dateTimeDate of symptom onset
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... Slices for value[x] ΣI1..1booleanActual result
Slice: Unordered, Closed by type:$this
.... value[x]:valueBoolean ΣI1..1booleanCostovertebral angle pain or tenderness (yes/no)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component Σ0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.

.... value[x] Σ0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet / Code
Observation.languagepreferredCommonLanguages
Max Binding: AllLanguages
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.codeexamplePattern: 3
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeexampleLOINCCodes
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes

Constraints

IdGradePathDetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorObservationIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6Best PracticeObservationA resource should have narrative for robust management
: text.`div`.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
: value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
swissnoso-obs-2errorObservationIf this symptom exists (valueBoolean = true), then a date must be specified
: (valueBoolean = true and effectiveDateTime.exists()) or (valueBoolean = false)
ele-1errorObservation.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorObservation.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorObservation.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorObservation.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorObservation.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.basedOnAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.partOfAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.subjectAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.focusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.encounterAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.effective[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.effective[x]:effectiveDateTimeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.issuedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.performerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.value[x]:valueBooleanAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.dataAbsentReasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.interpretationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.noteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.bodySiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.methodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.specimenAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.deviceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.referenceRangeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
obs-3errorObservation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
ele-1errorObservation.referenceRange.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorObservation.referenceRange.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorObservation.referenceRange.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorObservation.referenceRange.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorObservation.referenceRange.lowAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.referenceRange.highAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.referenceRange.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.referenceRange.appliesToAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.referenceRange.ageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.referenceRange.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.hasMemberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.derivedFromAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.componentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.component.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorObservation.component.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorObservation.component.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorObservation.component.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorObservation.component.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.component.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.component.dataAbsentReasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.component.interpretationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorObservation.component.referenceRangeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())