ACCESS Gateway EHR Specification HL7 FHIR® Implementation Guide-v1.0.0-WIP-draft

Profiling Principles for Lab Profiles

Observation & DiagnosticReport

The lab profiles were drafted with the following principles in mind:

Principle 1: Focus on citizen access Prioritize the FHIR elements that are critical to enhancing citizen access and interaction with their lab result information. While the medication profiles offer a profile for citizen access and a profile for clinician access, existing clinician viewers/interfaces already exist for lab information.

Principle 2: Focus on general lab results

  • In the examined LIS specifications, the message structure for microbiology, pathology, serology, and blood bank vary significantly from how the messages are formatted for general labs.
    • Typically in the Nova Scotia & Prince Edward Island LIS examples, pathology, microbiology, and serology were rendered/dictated text reports with each line of the report represented as an OBX-5 value (many OBX lines), while general labs had more structured data throughout the OBR and OBX fields.
    • Without data existing in structured known locations, it's very difficult to ensure that the data is mapped to the correct FHIR element.
  • Additionally, Subject Matter Expert (SME) review indicated that general labs should be prioritized as they offer the most value for early citizen access use cases.

Principle 3: Target alignment with US Core, CA Core, and OLIS profile

  • The DiagnosticReport and Observation profiles were designed with alignment (or at least compatibility) with existing implementations in mind. The goal was to enable pan-Canadian interoperability while avoiding a proliferation of competing and mutually incompatible standard or profiles.
    • The profiles targeted the US Core R4 Profiles due to their existing adoption as well as their use in the efforts to establish a Canadian Core profiles
    • The lab focused profiles targeted OLIS profiles and specification given their maturity and current adoption.

Principle 4: Ensure constraint decisions are source-aware

  • Focus on FHIR elements that map to HL7v2 ORU fields that are available across LIS and jurisdictions.
    • Given that jurisdictions are currently storing and exchanging much of the lab information using HL7 v2 messages, FHIR efforts will likely involve some transformation of source data into target FHIR elements.