Patient

Purpose

To track a patient, identify within shared systems and maintain complete records. To apply processes applicable to deceased patient requests, patient contact and urgency purposes. Data needed to support genetic interpretation, for PLCM to locate further patient ODS codes for a given test and to link patients to potential family members and their genetic results.

Notes

Mapped to Patient resource, extensions not in UKCore are under review. Representation of Karyotypic Sex is through an Observation with code under Karyotype (cell structure) - SCTID: 734840008 or Anomaly of sex chromosome (disorder) - SCTID: 95462004 (these codes are under review). Representation of pregnancy and gestation is under discussion.

It is expected that practitioner and organization details for GPs will be referenced from Patient.generalPractitioner (e.g. using ODS/SDS identifiers) rather than be included as FHIR resources within Test Request payloads, though the full FHIR mapping has been provided below for completeness.

Profiling for Procedure is currently in progress

Mapping

Source Data item Target FHIR Element HL7v2.5.1 Mapping Description
Patient - Is relative N/A determined through patient attached to ServiceRequest.subject N/A determined though first PID segment in OML message (relatives referenced through NK1 segments) Confirmation if this patient is the reported-on patient or a supplementary relative.
Patient - NHS number Patient.identifier:system = https://fhir.nhs.uk/Id/nhs-number PID-3 where PID-3.5=2.16.840.1.113883.2.1.3.2.4.18.23 Patient NHS number.
Patient - Local identifier Patient.identifier:system != https://fhir.nhs.uk/Id/nhs-number PID-3 where PID-3.5 = 2.16.840.1.113883.2.1.3.2.4.18.24 Patient identification code such as an NHS number.
Patient - Reason for unavailable NHS number Patient.extension:nhsNumberUnavailableReason N/A, could use PID-32 as surrogate Reason for an NHS number not being provided.
Patient - Withheld identity reason Additional codes to be part of Patient.extension:nhsNumberUnavailableReason ValueSet (as per NHS Data Model and Dictionary, pending addition) N/A, could use PID-32 as surrogate Confirmation why the patient is withholding identity details.
Patient - First name Patient.name.given PID-5.2 Patient's first name.
Patient - Surname Patient.name.family PID-5.1 Patient's last name.
Patient - Date of birth Patient.birthDate PID-7 Patient's date of birth.
Patient - Address Patient.address PID-11 Patient's home address.
Patient - Postcode Patient.address.postalCode PID-11.5 Patient's home postcode.
Patient - Country Patient.address.country PID-11.6 Patient's home country.
Patient - Life status at time of request Patient.deceasedBoolean PID-30 Patient's alive or deceased status.
Patient - Date of death Patient.deceasedDateTime PID-29 Patient's date/time of death.
Patient - Relationship to proband RelatedPerson.relationship NK1-3 Relative's relationship to proband/index.
Patient - Ethnicity Patient.extension:EthnicCategory PID-22 Patient's ethnicity. Will have the option 'unknown' available.
Patient - Sex assigned at birth Patient.extension:birthSex PID-8 Patient's phenotypic sex classification. The external physical characteristics of the person. Determined by the Dr / birth gender.
Patient - Gender Identity same as at birth N/A inferred through difference between Patient.extension:birthSex and Patient.extension:patient-genderIdentity N/A - not part of the HL7v2 standard, though PID-8 or an OBX segment could be used Confirmation if the patient's gender is the same as at birth.
Patient - Gender Identity Patient.extension:patient-genderIdentity N/A - not part of the HL7v2 standard, though PID-8 or an OBX segment could be used Patient's stated gender. The gender by which the person is addressed. Determined by the patient.
Patient - Sexual orientation Observation.code( subject=Patient ) OBX-5 with appropriate SNOMED/READ/LOINC code Patient's sexual orientation.
Patient - Karyotypic sex Observation.code( subject=Patient ) OBX-5 with appropriate SNOMED/READ/LOINC code Patient's genomic / karyotypic characteristics. Determined after laboratory testing.
Patient - GP Practice ODS Code Patient.generalPractitioner( PractitionerRole.organization( Organization.identifier ) ) PD1-4.14 Patient's GP practice ODS code.
Patient - GP full name Patient.generalPractitioner( PractitionerRole.practitioner( Practitioner.name ) ) PD1-4.2 and PD1-4.3 Patient's GP's full name.
Patient - GP GMC number Patient.generalPractitioner( PractitionerRole.practitioner( Practitioner.identifier ) ) PD1-4.1 Patient's GP's professional registration number.
Patient - Pedigree/Family Identifier Patient.identifier:pedigreeNumber Additional identifiers under PID-3 Patient's genetic/pedigree number which links their family.
Patient - Pregnancy status Observation.code( subject=Patient ) OBX-5 with appropriate SNOMED/READ/LOINC code Patient's pregnancy status.
Patient - Pregnancy gestation period Observation.component.valueDuration with code for gestation OBX-14 (subtracted from ORC-9) Patient's term of active pregnancy at point of test request.
Patient - Fetal gestation As above, though could be inferred through difference between Observation.effectiveDateTime for pregnancy and Procedure.performedDateTime for termination OBX-14 (subtracted from OBR-7 for termination procedure) Stage during patient pregnancy at which it terminated.
Patient - Estimated Delivery Date (EDD) As above, though could be inferred through Observation.effectiveDateTime for pregnancy + 40 weeks or new observation with code 161714006 OBX-14 + 40 weeks Patient's estimated delivery date.
Patient - Pregnancy type Inferred through presence of Procedure with codes under IUI/IVF OBR segments with appropriate codes Type of conception.
Patient - Fetal karyotypic sex Observation.code( subject.display="fetus" ) OBX-5 with appropriate SNOMED/READ/LOINC code Absence or presence of Y chromosome in the fetus.
Patient - Had transplant Inferred through presence of Procedure( subject=Patient ) with code under 77465005 - Transplantation Presence of OBR segment with OBR-44 code for transplant Has the patient ever had a transplant.
Patient - Type of transplant Procedure.code( subject=Patient ) OBR-44 What type of transplant the patient had. (Bone marrow / Stem cell)
Patient - Transplant date Procedure.performedDateTime( subject=Patient ) OBR-7 When the patient had the transplant.
Patient - Had transfusion Inferred through presence of Procedure( subject=Patient ) with code under 5447007 - Transfusion Presence of OBR segment with OBR-44 code for transplant Has the patient ever had a transfusion.
Patient - Type of transfusion Procedure.code( subject=Patient ) OBR-7 What type of transfusion the patient has had. (Packed Red Cells /Plasma / Platelets)
Patient - Transfusion date Procedure.performedDateTime( subject=Patient ) OBR-7 When the patient had the transfusion.
Patient - Is from consanguinous union FamilyMemberHistory.extension = family-member-history-genetics-observation( Observation.code=842009 ) or Observation attached to Patient OBX-5 with appropriate SNOMED/READ/LOINC code The fact of biological parents being descended from the same ancestor.
Patient - Height (m) Observation.valueQuantity( code=54871000237100, subject=Patient) OBX-5 Patient's height.