Notice
- Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
- This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from the NHS England Genomics Unit.
WGS Test Request - Cancer
The Cancer test order process is equivalent for WGS and Non-WGS tests.
For WGS, it is expected the Process Genomic Test Request Task would be routed to GEL to allow raising of the request in NGIS. The ServiceRequest.category would indicate the test is a 'cancer-wgs' test as with the WGS Rare Disease scenario.
All WGS tests are expected to include a RoD form: Questionnaire-Genomic Testing
For the WGS Tumour First, Germline Later use case, it is expected requesters would submit an additional ServiceRequest for the Germline Later test, using ServiceRequest.basedOn to reference the initial Tumour First test.
A summary of the resource graph/links for a Tumour First and Germline Late request are provided in the diagram below. Clinical context is inherited from the Tumour First request so supportingInfo does not need to be repeated in the Germline Late request and only new information or details specific to the Germline Late request need to be added, e.g. Germline specimen.
Any updates to clinical context should be made as updates to the prior resources, linked from the Tumour First request rather than being recreated on the Germline Late. In general, updates should follow FHIR RESTful rules, i.e. clients only need to submit the resources being updated, rather than recreating the complete TFGL bundles (as with messaging).
Any references to shared resources, such as Patient or PractitionerRole SHALL reference the existing resource, rather than creating a duplicate resource:
Link to the High Fidelity Wireframe for the WGS Cancer Test Order Form
Examples for Solid Tumour Test
ServiceRequest-WGSTestOrderForm-CancerSolidTumor-Example
Specimen-SolidTumorDemeizaSeo-Example
Observation-TumourTypeDemeizaSeo-Example
Observation-PercentageMalignantNuclei-Example
BodyStructure-BodySiteLocationAbdomen-Example
This would result in a set of Tasks for processing of the order, e.g.:
Task-WGSCancerTestOrder-SolidTumor-Example
Examples for HeamOnc Test (Tumour First - Germline Late)
1. Tumour First request
For the Tumour First - Germline Late scenario, the Tumour First test request is first created:
ServiceRequest-WGSTestOrderForm-CancerHaemOnc-Example
Specimen-PatrickSammyBoneMarrowAspiration-Example
Observation-PatrickSammyNoBoneMarrowTransplant-Example
Observation-NucleatedCellCountWGSSample-Example
Observation-BlastPercentageWGSSample-Example
Condition-AcuteMyeloidLeukaemia-Example
2. Germline Late Request
Next, a new request for the Germline sample is created, based on the previous Tumour First request:
ServiceRequest-WGSTestOrderForm-GermlineLate-Example
Specimen-PatrickSammyBloodEDTA-Example
3. Task Management
Tasks for each ServiceRequest will be created independently, it is up to client systems to link the 2 requests and progress tasks across the 2 requests.