CA Core+ v1.1.0 DFT-preBallot
1.1.0-DFT-preBallot 
DFT-preBallot - The specification is a DFT-preBallot version of CA Core+ for collecting community feedback. For a full list of available versions, see the Directory of published versions
DiagnosticReport (CA-Core)
Links
Profile
Derived from
http://hl7.org/fhir/StructureDefinition/DiagnosticReport
Examples
example-diagnosticreport-pathology-ca-core, example-diagnosticreport-radiology-ca-core
Description
This profile applies constraints to the DiagnosticReport resource for CA Core+ to support diagnostic summaries such as lab and imaging reports in the pan-Canadian context.
References to this resource
CFMM: 2
Resource Content
</extension>
<url value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/diagnosticreport-ca-core" />
</telecom>
</telecom>
</contact>
<description value="This profile applies constraints to the DiagnosticReport resource for CA Core+ to support diagnostic summaries such as lab and imaging reports in the pan-Canadian context." />
</jurisdiction>
<copyright value="Copyright © 2025+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." />
<comment value="Mapping for DiagnosticReportCACore to Canadian Core Data for Interoperability (CACDI)." />
</mapping>
<short value="A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports" />
<definition value="The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports." />
<comment value="This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing." />
</base>
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
</constraint>
<human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource" />
<expression value="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()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
</constraint>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
</base>
</extension>
</type>
</element>
<definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource." />
</base>
</type>
</constraint>
</element>
<definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc." />
<comment value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
</element>
<comment value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)." />
</base>
</type>
</constraint>
</extension>
</extension>
</extension>
</binding>
</element>
<definition value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety." />
<comment value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope." />
<comment value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels." />
</base>
</type>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
</mapping>
</element>
<comment value="Usually assigned by the Information System of the diagnostic service provider (filler id)." />
<requirements value="Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4" />
</mapping>
</mapping>
</element>
<comment value="Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports." />
<requirements value="This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/medicationrequest-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/servicerequest-ca-core" />
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<requirements value="Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
</extension>
</binding>
</mapping>
</mapping>
</mapping>
<map value="statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"" />
</mapping>
</element>
</extension>
</extension>
<definition value="A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text." />
<comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
<map value="inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code" />
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
<definition value="A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text." />
<comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
<map value="OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)" />
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/location-ca-core" />
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about." />
<comment value="This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests)." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core" />
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself." />
<comment value="If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic." />
</base>
</type>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified." />
<comment value="May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<comment value="This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report." />
<requirements value="Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core" />
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The practitioner or organization that is responsible for the report's conclusions and interpretations." />
<requirements value="Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core" />
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group." />
<requirements value="Need to be able to report information about the collected specimens on which the report is based." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<requirements value="Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images." />
<comment value="ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest)." />
<requirements value="Many diagnostic services include images in the report as part of their service." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
<definition value="A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features." />
<comment value="The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion." />
<requirements value="The provider of the report should make a comment about each image included in the report." />
</base>
</type>
</constraint>
<map value=".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value" />
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report." />
<requirements value="Need to be able to provide a conclusion that is not lost among the basic result data." />
</base>
</type>
</constraint>
</mapping>
<map value="inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)" />
</mapping>
</element>
<definition value="One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
<map value="inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)" />
</mapping>
</element>
<definition value="Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent." />
<comment value=""application/pdf" is recommended as the most reliable and interoperable in this context." />
<requirements value="Gives laboratory the ability to provide its own fully formatted report for clinical fidelity." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</snapshot>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/medicationrequest-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/servicerequest-ca-core" />
</type>
</element>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</element>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</binding>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/location-ca-core" />
</type>
</mapping>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core" />
</type>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core" />
</type>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core" />
</type>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</differential>
</StructureDefinition>
{
],
{
{
},
{
}
]
}
],
"description": "This profile applies constraints to the DiagnosticReport resource for CA Core+ to support diagnostic summaries such as lab and imaging reports in the pan-Canadian context.",
],
"copyright": "Copyright © 2025+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
{
}
],
{
"short": "A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports",
"definition": "The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.",
"comment": "This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.",
"Report",
"Test",
"Result",
"Results",
"Labs",
"Laboratory"
],
},
{
},
{
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"expression": "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()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
},
{
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
},
{
},
{
{
},
{
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
},
{
{
}
],
}
],
},
{
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
},
],
{
}
],
},
{
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
},
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
},
{
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
},
],
{
}
],
{
},
{
},
{
}
],
}
},
{
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"narrative",
"html",
"xhtml",
"display"
],
},
],
{
}
],
]
},
{
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"inline resources",
"anonymous resources",
"contained resources"
],
},
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"extensions",
"user content"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
]
},
{
"comment": "Usually assigned by the Information System of the diagnostic service provider (filler id).",
"requirements": "Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.",
"ReportID",
"Filler ID",
"Placer ID"
],
},
],
{
}
],
{
},
{
},
{
"map": "OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4"
},
{
}
]
},
{
"comment": "Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.",
"requirements": "This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.",
"Request"
],
},
{
"http://hl7.org/fhir/StructureDefinition/CarePlan",
"http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/medicationrequest-ca-core",
"http://hl7.org/fhir/StructureDefinition/NutritionOrder",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/servicerequest-ca-core"
]
}
],
{
}
],
{
},
{
},
{
}
]
},
{
"requirements": "Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.",
},
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
{
}
],
},
{
},
{
},
{
},
{
"map": "statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type \"revise\""
}
]
},
{
{
},
{
}
],
"definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"Department",
"Sub-department",
"Service",
"Discipline"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
],
"ele-1"
],
{
}
],
{
}
],
},
{
},
{
},
{
"map": "inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code"
},
{
},
{
},
{
},
{
}
]
},
{
{
},
{
}
],
"definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"Type"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
],
"ele-1"
],
{
}
],
{
}
],
},
{
},
{
},
{
"map": "OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)"
},
{
},
{
},
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.",
"Patient"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/Group",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/location-ca-core"
]
}
],
{
}
],
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"definition": "The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.",
"comment": "This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).",
"Context"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core"
]
}
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.",
"comment": "If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.",
"Observation time",
"Effective Time",
"Occurrence"
],
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.",
"comment": "May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.",
"Date published",
"Date Issued",
"Date Verified"
],
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"comment": "This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.",
"requirements": "Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.",
"Laboratory",
"Service",
"Practitioner",
"Department",
"Company",
"Authorized by",
"Director"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "The practitioner or organization that is responsible for the report's conclusions and interpretations.",
"requirements": "Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.",
"Analyzed by",
"Reported by"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"comment": "If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.",
"requirements": "Need to be able to report information about the collected specimens on which the report is based.",
},
],
{
}
],
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"requirements": "Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.",
"Data",
"Atomic Value",
"Result",
"Atomic result",
"Data",
"Test",
"Analyte",
"Battery",
"Organizer"
],
},
],
{
}
],
{
},
{
}
]
},
{
"definition": "One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.",
"comment": "ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.",
},
{
}
],
{
}
],
{
}
]
},
{
"definition": "A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).",
"DICOM",
"Slides",
"Scans"
],
},
],
{
}
],
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
"definition": "A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.",
"comment": "The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.",
"requirements": "The provider of the report should make a comment about each image included in the report.",
},
],
{
}
],
{
"map": ".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value"
}
]
},
{
},
],
{
}
],
]
},
{
"definition": "Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.",
"requirements": "Need to be able to provide a conclusion that is not lost among the basic result data.",
"Report"
],
},
],
{
}
],
{
},
{
"map": "inboundRelationship[typeCode=\"SPRT\"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)"
}
]
},
{
"definition": "One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.",
},
],
{
}
],
{
}
],
},
{
},
{
"map": "inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)"
}
]
},
{
"definition": "Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.",
"comment": "\"application/pdf\" is recommended as the most reliable and interoperable in this context.",
"requirements": "Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.",
},
],
{
}
],
]
}
]
},
{
{
"http://hl7.org/fhir/StructureDefinition/CarePlan",
"http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/medicationrequest-ca-core",
"http://hl7.org/fhir/StructureDefinition/NutritionOrder",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/servicerequest-ca-core"
]
}
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
],
}
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/Group",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/location-ca-core"
]
}
],
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core"
]
}
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/organization-ca-core",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
}
]
}
}
Terminology bindings
| Path | Conformance | ValueSet |
|---|---|---|
| DiagnosticReport.code | preferred | https://fhir.infoway-inforoute.ca/ValueSet/pCLOCD |
Additional Terminology Bindings
These bindings may be used in lieu of the primary bindings in the table above.
Mappings to CACDI
The following tables list how the data elements from CA Core+ map to CACDI. For more information visit Mapping Logic.
| FHIR Profile Element | CACDI Element(s) |
|---|---|
| DiagnosticReport.subject | Patient |