How to construct Message Bundles

Definitions for messages are included in MessageDefinitions. However, please note the definitions are only indicative of the resources expected in a request/report transaction, as the central services will use RESTful transactions rather than messages. Additional resources can be sent as long as they are not orphaned (not referenced from other resources in the transaction).

The bundles currently defined for the Genomic Medicine Service are the Genomic-Test-Request, which includes the original test order and associated information, and the Genomic-Test-Response, which is the final diagnostic report and associated information return by the genomic lab.

The use of messages within the Genomic Medicine Service, over a completely RESTful interface is currently under review.

Request Bundle contents

Genetic Testing Request

The genetic testing information is exchanged using FHIR Transaction Bundle. This section shows the Bundle structure and the relationship between the resources which make up the Bundle.

The Bundle uses the following resource to carry the related business entity information:

Test Request Summary - This business entity is used to capture details of the test and supporting information from the requestor and uses the ServiceRequest FHIR resource.

The data items and resources used in the Request Bundle are mapped from the Genomics Minimum Dataset (Clinical headings)

The following diagram identifies key fhir resources included within a Genetic Testing Request bundle, and how these resources are related.

GMS Test Request Logical Model v2

Result Bundle contents

Genetic Testing Response

The genetic testing response information is exchanged using FHIR Transaction Bundle. This section shows the example Bundle structure and the relationship between the resources which make up the Bundle.

The Bundle uses the following resource to carry the related business entity information:

Test Request Response - This business entity is used to capture details of the genetic testing response and uses the DiagnosticReport FHIR resource.

The data items and resources used in the Response Bundle are mapped from the Genomics Reporting IG, published by the HL7 Clinical Genomics Working Group. This model is still under review for use in the UK.

The following diagram identifies key fhir resources included within a National Diagnostics - Genetic Testing Response bundle, and how these resources are related.

GMS Report Response Logical Model v2

Bundle referencing

Resources in Bundles SHOULD NOT use contained resources.

References to other resources in the Bundle SHOULD use the fullUrl uuid, e.g.

"reference": "urn:uuid:66c519dd-423f-4238-89c8-91c5be52f330"

References to other resources not included in the Bundle SHOULD use the path for the resource, including the uuid, if this can be found on the GMS central broker e.g.

"reference": "Specimen/840d075e-0480-4134-ae51-27f572731cc8"

If the resource is hosted on another NHS service, for example patient records on PDS, these should be referenced by identifier using the appropriate system for the identifier e.g.

"reference": {
  "identifier": {
    "system": "https://fhir.nhs.uk/Id/nhs-number",
    "value": "9999999999"
  }
}

If a resource is contained on another system, outside NHS central services, this SHOULD be referenced with an absolute url. The URL SHALL be resolvable and preferably return a FHIR resource of the appropriate type e.g.

"reference": "https://www.christie.nhs.uk/ehr/LabOrder123456"

All profiles within transaction bundles should reference each other i.e. none should be orphaned.

Any additional resources not linked from another resource in a transaction bundle SHALL be excluded, or sent in a separate transaction. The expected list of resources and cardinalities in a typical test order or report transaction are detailed in MessageDefinitions.

Resource Reference (Duo/Trio Tests)

When the test type is Duo or Trio there will usually be specimens from more than one patient. Due to the way references work within FHIR, the Task resource will reference the Specimen resources for all participants within the “input” element, and each specimen will reference the patient it relates to using the “subject” element.

duo specimen