Pathology Bundle Renal Function Tests Example

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<resource>
<Patient>
<id value="9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
</meta>
<identifier>
<extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus">
<valueCodeableConcept>
<coding>
<system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-NHSNumberVerificationStatus" />
<code value="01" />
<display value="Number present and verified" />
</coding>
</valueCodeableConcept>
</extension>
<system value="https://fhir.nhs.uk/Id/nhs-number" />
<value value="9432003812" />
</identifier>
<name>
<use value="official" />
<family value="Stanner" />
<given value="Lisa" />
</name>
<gender value="female" />
<birthDate value="1960-05-20" />
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:e1df1431-22ac-462a-946a-f195f6c640bh" />
<resource>
<ServiceRequest>
<id value="e1df1431-22ac-462a-946a-f195f6c640bh" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-ServiceRequest" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="8f9bbd01-4e52-420d-b05b-48bc671d6819" />
</identifier>
<status value="active" />
<intent value="order" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="54610007" />
<display value="Kidney panel" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<requester>
<reference value="urn:uuid:g25e9d63-6a4e-4de6-b9dc-c912fda62c02" />
<display value="GREEN" />
</requester>
<performer>
<reference value="urn:uuid:cf7a76d3-5b44-4194-a9e0-d1cc1ea5e51f" />
<display value="MANOR GP PRACTICE" />
</performer>
</ServiceRequest>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:ffae5859-28df-4e7d-be91-6df56d8215f5" />
<resource>
<DiagnosticReport>
<id value="ffae5859-28df-4e7d-be91-6df56d8215f5" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-DiagnosticReport" />
</meta>
<!-- Test Request Summary -->
<identifier>
<system value="http://acme.com/MidtownDHL/reports" />
<value value="5234355" />
</identifier>
<basedOn>
<reference value="urn:uuid:e1df1431-22ac-462a-946a-f195f6c640bh" />
</basedOn>
<status value="final" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="721981007" />
<display value="Diagnostic studies report" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<issued value="2019-11-04T12:00:00+00:00" />
<performer>
<reference value="urn:uuid:e6407de7-0e86-45eb-93cb-035094aaa50f" />
<display value="Midtown District Hospital (Blood Sciences)" />
</performer>
<specimen>
<reference value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
</specimen>
<result>
<reference value="urn:uuid:ebcb177a-9501-4dcc-8b22-b941791ae1ec" />
</result>
</DiagnosticReport>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
<resource>
<Specimen>
<id value="866a8361-79ce-4561-afcb-a91fe19dg234" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Specimen" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="2c663fc5-9dec-49c0-9eed-18a7cfa5a6c3" />
</identifier>
<accessionIdentifier>
<system value="http://lab.acme.org/specimens/2020/MidtownDHL" />
<value value="X352377" />
</accessionIdentifier>
<status value="available" />
<type>
<coding>
<system value="http://snomed.info/sct" />
<code value="119361006" />
<display value="Plasma specimen" />
</coding>
</type>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<receivedTime value="2019-11-01T15:00:00+00:00" />
<collection>
<collectedDateTime value="2019-11-01T11:00:00+00:00" />
</collection>
</Specimen>
</resource>
</entry>
<!-- Renal function tests -->
<entry>
<fullUrl value="urn:uuid:ebcb177a-9501-4dcc-8b22-b941791ae1ec" />
<resource>
<Observation>
<id value="ebcb177a-9501-4dcc-8b22-b941791ae1ec" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="5ff46949-4938-4c57-bad4-c4363e1965g7" />
</identifier>
<status value="final" />
<!-- Renal function tests -->
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1015971000000100" />
<display value="Renal function tests" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<effectiveDateTime value="2019-11-01T15:00:00+00:00" />
<performer>
<reference value="urn:uuid:e6407de7-0e86-45eb-93cb-035094aaa50f" />
<display value="Midtown District Hospital (Blood Sciences)" />
</performer>
<specimen>
<reference value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
</specimen>
<!-- Component of Test of Battery 1 -->
<hasMember>
<!-- Sodium substance concentration in serum -->
<reference value="urn:uuid:6c1be8a9-bba0-4941-bb77-93d9fd3b1gbc" />
</hasMember>
<hasMember>
<!-- Potassium substance concentration in serum -->
<reference value="urn:uuid:bb99bda1-a118-4463-806d-c88681c842b9" />
</hasMember>
<hasMember>
<!-- Chloride substance concentration in serum -->
<reference value="urn:uuid:5eda41b3-4f58-45e1-9854-458d89d38162" />
</hasMember>
<hasMember>
<!-- Creatinine substance concentration in serum -->
<reference value="urn:uuid:b3751035-ee56-4135-a265-8dfa0e8b0683" />
</hasMember>
<hasMember>
<!-- Estimated glomerular filtration rate by laboratory calculation -->
<reference value="urn:uuid:108a4300-b289-4806-add6-32aad4725370" />
</hasMember>
</Observation>
</resource>
</entry>
<!-- Renal function test: Sodium substance concentration in serum -->
<entry>
<fullUrl value="urn:uuid:6c1be8a9-bba0-4941-bb77-93d9fd3b1gbc" />
<resource>
<Observation>
<id value="6c1be8a9-bba0-4941-bb77-93d9fd3b1gbc" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="6gf46949-4938-4c57-bad4-c4363e1965h8" />
</identifier>
<status value="final" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1107871000000107" />
<display value="Sodium substance concentration in serum" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<effectiveDateTime value="2019-11-01T15:00:00+00:00" />
<performer>
<reference value="urn:uuid:e6407de7-0e86-45eb-93cb-035094aaa50f" />
<display value="Midtown District Hospital (Blood Sciences)" />
</performer>
<valueQuantity>
<value value="142" />
<unit value="mmol/L" />
<system value="https://unitsofmeasure.org" />
<code value="mmol/L" />
</valueQuantity>
<specimen>
<reference value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
</specimen>
<referenceRange>
<low>
<value value="133" />
</low>
<high>
<value value="146" />
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<!-- Renal function test: Potassium substance concentration in serum -->
<entry>
<fullUrl value="urn:uuid:bb99bda1-a118-4463-806d-c88681c842b9" />
<resource>
<Observation>
<id value="bb99bda1-a118-4463-806d-c88681c842b9" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="7if46949-4938-4c57-bad4-c4363e1965i8" />
</identifier>
<status value="final" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1107761000000109" />
<display value="Potassium substance concentration in serum" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<effectiveDateTime value="2019-11-01T15:00:00+00:00" />
<performer>
<reference value="urn:uuid:e6407de7-0e86-45eb-93cb-035094aaa50f" />
<display value="Midtown District Hospital (Blood Sciences)" />
</performer>
<valueQuantity>
<value value="4.8" />
<unit value="mmol/L" />
<system value="https://unitsofmeasure.org" />
<code value="mmol/L" />
</valueQuantity>
<specimen>
<reference value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
</specimen>
<referenceRange>
<low>
<value value="3.5" />
</low>
<high>
<value value="5.3" />
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<!-- Renal function test: Chloride substance concentration in serum -->
<entry>
<fullUrl value="urn:uuid:5eda41b3-4f58-45e1-9854-458d89d38162" />
<resource>
<Observation>
<id value="5eda41b3-4f58-45e1-9854-458d89d38162" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="8jf46949-4938-4c57-bad4-c4363e1965j8" />
</identifier>
<status value="final" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1106511000000102" />
<display value="Chloride substance concentration in serum" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<effectiveDateTime value="2019-11-01T15:00:00+00:00" />
<performer>
<reference value="urn:uuid:e6407de7-0e86-45eb-93cb-035094aaa50f" />
<display value="Midtown District Hospital (Blood Sciences)" />
</performer>
<valueQuantity>
<value value="105" />
<unit value="mmol/L" />
<system value="https://unitsofmeasure.org" />
<code value="mmol/L" />
</valueQuantity>
<specimen>
<reference value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
</specimen>
<referenceRange>
<low>
<value value="95" />
</low>
<high>
<value value="108" />
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<!-- Renal function test: Creatinine substance concentration in serum -->
<entry>
<fullUrl value="urn:uuid:b3751035-ee56-4135-a265-8dfa0e8b0683" />
<resource>
<Observation>
<id value="b3751035-ee56-4135-a265-8dfa0e8b0683" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="8kf46949-4938-4c57-bad4-c4363e1965k8" />
</identifier>
<status value="final" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1107001000000108" />
<display value="Creatinine substance concentration in serum" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<effectiveDateTime value="2019-11-01T15:00:00+00:00" />
<performer>
<reference value="urn:uuid:e6407de7-0e86-45eb-93cb-035094aaa50f" />
<display value="Midtown District Hospital (Blood Sciences)" />
</performer>
<valueQuantity>
<value value="64" />
<unit value="umol/L" />
<system value="https://unitsofmeasure.org" />
<code value="umol/L" />
</valueQuantity>
<specimen>
<reference value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
</specimen>
<referenceRange>
<low>
<value value="48" />
</low>
<high>
<value value="128" />
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<!-- Renal function test: Estimated glomerular filtration rate by laboratory calculation -->
<entry>
<fullUrl value="urn:uuid:108a4300-b289-4806-add6-32aad4725370" />
<resource>
<Observation>
<id value="108a4300-b289-4806-add6-32aad4725370" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="9lf46949-4938-4c57-bad4-c4363e1965l9" />
</identifier>
<status value="final" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1107411000000104" />
<display value="Estimated glomerular filtration rate by laboratory calculation" />
</coding>
</code>
<subject>
<reference value="urn:uuid:9d6c2cd5-0eec-496a-88d0-3785a135dg10" />
<display value="STANNER, Lisa" />
</subject>
<effectiveDateTime value="2019-11-01T15:00:00+00:00" />
<performer>
<reference value="urn:uuid:e6407de7-0e86-45eb-93cb-035094aaa50f" />
<display value="Midtown District Hospital (Blood Sciences)" />
</performer>
<valueQuantity>
<value value="87" />
<unit value="mL/min/1.73m2" />
<system value="https://unitsofmeasure.org" />
<code value="mL/min/((173/100).m2)" />
</valueQuantity>
<note>
<text value="The EGFR quoted must be multiplied by 1.2 if the patient is of Afro-Caribbean origin." />
</note>
<specimen>
<reference value="urn:uuid:866a8361-79ce-4561-afcb-a91fe19dg234" />
</specimen>
</Observation>
</resource>
</entry>
</Bundle>

Clinical Scenario

This example is based on the following Pathology scenario

Description

Lisa Stanner, a 60 year old woman, attends Manor GP Practice for monitoring her hypertension. Lisa’s GP, Dr Jane Green, requests renal function tests (electrolytes and creatinine profile). The request is sent electronically using an order comms system (accessed via the GP practice system) to the pathology laboratory based in the local hospital, Midtown District Hospital.

Dr Green books an appointment with the practice nurse, Alice Jones. Lisa attends the appointment the following day where the blood sample is taken and sent to the laboratory.

The sample is received by the laboratory, checked and matched with the test request. The details are recorded on the Laboratory Information Management System (LIMS).

The tests are performed, and the results are authorised for release. The following test results (and reference ranges) are sent electronically from the LIMS to the GP practice system:

Electrolytes and Creatinine Profile

Type Units Range
Sodium 142 mmol/L (133 to 146)
Potassium 4.8 mmol/L (3.5 to 5.3)
Chloride 105 mmol/L (95 to 108)
Creatinine 64 umol/L (48 to 128)
EGFR 87 mL/min/1.73m2
Comments The EGFR quoted above must be multiplied by 1.2 if the patient is of Afro-Caribbean origin.

Named participants

  • Patient: Patient: Lisa Stanner – FHIR Resource: Patient
  • Requesting HCP: Dr Jane Green – FHIR Resource: Practitioner

Named Organisations

  • Requesting Organisation: Manor GP Practice – FHIR Resource: Organization
  • Specimen Collecting Organisation: Manor GP Practice – FHIR Resource: Organization
  • Performing Organisation: Midtown District Hospital (Blood Sciences) – FHIR Resource: Organization

Required Tests

Code Display
54610007 Kidney panel

Specimen(s)

Code Display
119361006 Plasma specimen

Test Report

Code Display
721981007 Diagnostic studies report

Test Results

Code Display Value Unit
1015971000000100 Renal function tests - -
1107871000000107 Sodium substance concentration in serum 142 mmol/L
1107761000000109 Potassium substance concentration in serum 4.8 mmol/L
1106511000000102 Chloride substance concentration in serum 105 mmol/L
1107001000000108 Creatinine substance concentration in serum 64 umol/L
1107411000000104 Estimated glomerular filtration rate by laboratory calculation 87 mL/min/1.73m2