<status value="draft" /> <experimental value="false" /> <date value="2019-03-21T00:00:00-04:00" /> <publisher value="Canada Health Infoway" /> <contact> <telecom> <system value="url" /> <value value="http://infoway-inforoute.ca" /> </telecom> </contact> <description value="Constraints on the DiagnosticReport resource to reflect source data mappings for the ACCESS Health project. Focus of this profile is on display of general Diagnostic Report result information to citizen/patient viewers." /> <fhirVersion value="4.0.0" /> <mapping> <identity value="vendor-agnostic-v2" /> <uri value="http://unknown.org/Vendor Agnostic v2" /> <name value="Vendor Agnostic v2" /> </mapping> <mapping> <identity value="ontario--olis" /> <uri value="http://unknown.org/Ontario- OLIS" /> <name value="Ontario- OLIS" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <uri value="http://unknown.org/Prince Edward Island- Cerner Millennium" /> <name value="Prince Edward Island- Cerner Millennium" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <uri value="http://unknown.org/Nova Scotia- Meditech Magic" /> <name value="Nova Scotia- Meditech Magic" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <uri value="http://unknown.org/Nove Scotia- Cerner Millennium" /> <name value="Nove Scotia- Cerner Millennium" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <uri value="http://unknown.org/Nova Scotia- Meditech C/S" /> <name value="Nova Scotia- Meditech C/S" /> </mapping> <mapping> <identity value="workflow" /> <uri value="http://hl7.org/fhir/workflow" /> <name value="Workflow Pattern" /> </mapping> <mapping> <identity value="v2" /> <uri value="http://hl7.org/v2" /> <name value="HL7 v2 Mapping" /> </mapping> <mapping> <identity value="rim" /> <uri value="http://hl7.org/v3" /> <name value="RIM Mapping" /> </mapping> <mapping> <identity value="w5" /> <uri value="http://hl7.org/fhir/fivews" /> <name value="FiveWs Pattern Mapping" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="DiagnosticReport" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" /> <derivation value="constraint" /> <differential> <element id="DiagnosticReport"> <path value="DiagnosticReport" /> <short value="ACCESS DiagnosticReport General Lab (Patient) Profile" /> <definition value="Expected requirements for the DiagnosticReport resource when reflecting general lab result data based on existing source mappings." /> <comment value="Note for implementors: This profile focuses on general lab results. It excludes pathology, microbiology, serotology, etc for two reasons: 1) The density and content of information in the various lab types are dramatically different from each other, these differences drive different information and interaction requirements from patients, and 2) there is a large degree of variance in how general lab results are formatted (more structured) and how other types of labs like pathology are structured (largely text based). Additional analysis required for microbiology, serotology, and pathology lab result types to determine level of structured data available." /> <mustSupport value="false" /> <isModifier value="false" /> </element> <element id="DiagnosticReport.identifier"> <path value="DiagnosticReport.identifier" /> <short value="Business identifier for report" /> <type> <code value="Identifier" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-51 Other suggested options if OBR-51 is not available: OBR-2 + OBR-3 + OBR-4" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3 + ORC-4" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-2 + OBR-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-2 + OBR-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-2 + OBR-20" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-2 + OBR-3" /> </mapping> </element> <element id="DiagnosticReport.status"> <path value="DiagnosticReport.status" /> <short value="registered | partial | preliminary | final +" /> <comment value="Mapping Note: See the notes in the mapping document discussing the need to map the HL7 v2 codes used by the LIS (shorthand often single-digit codes) to the codes used by the FHIR value set (usually full word code)." /> <type> <code value="code" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="required" /> <description value="Diagnostic Report Status" /> <valueSet value="http://hl7.org/fhir/ValueSet/diagnostic-report-status" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-25 (not 1:1 mapping)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-25 (Codes supported: P, F, C, N, W, X, Z)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-25 (Codes supported: P, F, C, D, R, S, D, U, I) Could also receive codes from Cerner Millennium Code Set 8 (UNAUTH, TRANSCRIBED, C_TRANSCRIBED, INPROGRESS, AUTH, ALTERED, MODIFIED, INERROR, INERRNOMUT, INERRNOVIEW, CANCELLED, NOT DONE)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-25 (Codes supported: P, F, D, A*)" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-25 (Codes supported: P, F, C)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-25 (Codes supported: P, F, C, D, A*, FOUT*)" /> </mapping> </element> <element id="DiagnosticReport.category"> <path value="DiagnosticReport.category" /> <slicing> <discriminator> <type value="value" /> <path value="pattern" /> </discriminator> <rules value="open" /> </slicing> <short value="Service Category" /> <comment value="Laboratory should be the default code used in this diagnostic report profile. Other profiles may support other codes." /> <min value="1" /> <max value="*" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="example" /> <description value="Diagnostic Service Section Codes" /> <valueSet value="http://hl7.org/fhir/ValueSet/diagnostic-service-sections" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-24" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="?" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-24" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-24" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-24" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-24" /> </mapping> </element> <element id="DiagnosticReport.category.lab"> <path value="DiagnosticReport.category.lab" /> <min value="1" /> <max value="1" /> <type> <code value="CodeableConcept" /> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/v2-0074" /> <code value="LAB" /> </coding> </patternCodeableConcept> <mustSupport value="true" /> <isModifier value="false" /> </element> <element id="DiagnosticReport.code"> <path value="DiagnosticReport.code" /> <short value="Name/Code for this diagnostic report" /> <comment value="Implementor Note: US Core uses a value set that pulls from the LOINC Diagnostic Report codes but does not fix a certain value. OLIS pulls from LOINC but requires a fixed value of 11502-2 to identify the lab report. Keeping the LOINC value set as an example is intended to strike a balance between both profiles, but further investigation with jurisdictional end-users/LIS is recommended to determine if a fixed value should be pursued to reduce confusion and inconsistency for patients." /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="preferred" /> <description value="LOINC Diagnostic Report Codes" /> <valueSet value="http://hl7.org/fhir/ValueSet/report-codes" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-4" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-4" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-4" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-4" /> </mapping> </element> <element id="DiagnosticReport.subject"> <path value="DiagnosticReport.subject" /> <short value="The subject of the report" /> <min value="1" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="PID-3(MRN) , PID-2 (primary insurance policy number) should also be considered Other suggested options if PID-3 is not available or the patient resource is tied to provincial identifiers: PID-2 OR PID-4 (Depending on if HL7 v2.3 or lower)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="PID-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="PID-3 (if v2.3.1 and above), PID-4 (if v2.3 or below)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="PID-3" /> </mapping> </element> <element id="DiagnosticReport.effectiveDateTime"> <path value="DiagnosticReport.effectiveDateTime" /> <short value="Clinically relevant time/time-period for report" /> <type> <code value="dateTime" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-7 (Observation Date/Time)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-7" /> </mapping> </element> <element id="DiagnosticReport.issued"> <path value="DiagnosticReport.issued" /> <short value="DateTime this version was made" /> <comment value="Mapping note: Keep in mind that the instant data type requires seconds and time zone to be reported and the HL7 v2 ORU messages that are the source of the conversions are likely to only include YYYY-MM-DD-HH-DD. If hour and minute are unknown, the Meditech NS LIS append "UNK". Additional work will be required on behalf of the converter to add in zeros for seconds and time zone to be conformant to the FHIR Data type. There are no limitations from the base HL7 spec or NS implementation guides for time stamp that would prevent bi-directional conversion." /> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-22 (Results Rpt/Status Chng – Date/Time) Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 can be used if interface is HL7 v2.4 or higher" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="ZBX-1 (Test Result Release Date/Time)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-22" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-22" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-22" /> </mapping> </element> <element id="DiagnosticReport.performer"> <path value="DiagnosticReport.performer" /> <slicing> <discriminator> <type value="value" /> <path value="profile" /> </discriminator> <rules value="open" /> </slicing> <short value="Responsible Diagnostic Service" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> </type> <mustSupport value="true" /> <isModifier value="false" /> </element> <element id="DiagnosticReport.performer.practitioner"> <path value="DiagnosticReport.performer.practitioner" /> <short value="Practitioner responsible for the diagnostic report" /> <comment value="SME Note: Rare in general labs to have physicians that sign the lab result. Lab performing practitioner is usually internal information that gets stored by LIS for operational purposes, but not likely of value to patients or clinicians. Implementor Note: Included for alignment with existing Canadian & International profiles, kept as optional until reviewal by end-users determines removal or must-support flag." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-32 (Principal Result Interpreter) or OBX-16 (Responsible Observer)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-32" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-16 (not sent for all results)" /> </mapping> </element> <element id="DiagnosticReport.performer.organization"> <path value="DiagnosticReport.performer.organization" /> <short value="Organization responsible for the diagnostic report" /> <comment value="SME Note: Most commonly, performing organization will be available (more frequently than performing practitioner)." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-15 (Producer ID), OBX-23 (Performing Organization Name) if interface is HL7 2.5.1 and higher" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="ZBR-6 (Performing Laboratory)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-23" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="ZPS-2 (Meditech performing lab site mnemonic) / ZPS-3 (Meditech performing lab site name)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-15" /> </mapping> </element> <element id="DiagnosticReport.specimen"> <path value="DiagnosticReport.specimen" /> <short value="Specimens this report is based on" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-3.1 (Filler Order Number ID) SPM-2 (Specimen ID) can be used in interfaces that are HL7 v2.5.1 and higher" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="SPM-2.2" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 (Filler Field 1+ Unformatted Millennium accession number)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1" /> </mapping> </element> <element id="DiagnosticReport.result"> <path value="DiagnosticReport.result" /> <short value="Observations" /> <type> <code value="Reference" /> <targetProfile value="http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-21 (Observation Instance Identifier) Other suggested options if OBX-21 is not available: OBR-2 (Placer Order Number) + OBR-3(Filler Order Number) + OBX-3 (Observation Identifier)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> </element> <element id="DiagnosticReport.conclusion"> <path value="DiagnosticReport.conclusion" /> <short value="Clinical conclusion (interpretation) of test results" /> <type> <code value="string" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX. Or NTE-3 when NTE-2 data type is interpretive data" /> </mapping> </element> <element id="DiagnosticReport.conclusionCode"> <path value="DiagnosticReport.conclusionCode" /> <short value="Codes for the clinical conclusion of test results" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <binding> <strength value="example" /> <description value="SNOMED CT Clinical Findings" /> <valueSet value="http://hl7.org/fhir/ValueSet/clinical-findings" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX. Or NTE-3 when NTE-2 data type is interpretive data" /> </mapping> </element> </differential> </StructureDefinition>

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport				ACCESS DiagnosticReport General Lab (Patient) Profile
identifier			Identifier	Business identifier for report
status	S		code	registered \| partial \| preliminary \| final + Binding: DiagnosticReportStatus (required)
category	S		CodeableConcept	Service Category Slice: Unordered, Open by value:pattern Binding: DiagnosticServiceSectionCodes ( example )
lab	S	1..1	CodeableConcept	Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/v2-0074","code":"LAB"}]}
code	S		CodeableConcept	Name/Code for this diagnostic report Binding: LOINCDiagnosticReportCodes (preferred)
subject	S	1..1	Reference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient)	The subject of the report
effectiveDateTime	S		dateTime	Clinically relevant time/time-period for report
issued	S			DateTime this version was made
performer	S		Reference ( Practitioner \| Organization )	Responsible Diagnostic Service Slice: Unordered, Open by value:profile
practitioner			Reference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner)	Practitioner responsible for the diagnostic report
organization			Reference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization)	Organization responsible for the diagnostic report
specimen			Reference(Specimen)	Specimens this report is based on
result	S		Reference(ACCESS Observation General Lab (Patient) Profile)	Observations
conclusion			string	Clinical conclusion (interpretation) of test results
conclusionCode			CodeableConcept	Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example)
Documentation for this format