Genomics-Specimen

Used to capture information on Samples which will undergo or have undergone processing for genomic testing.

Within FHIR R4, there is no way to capture location against a sample to aid tracking, one of the key requirements of the Genomic Medicine Service. Investigation of a possible solution through backporting the container.location element within R5 is currently being investigated. Until this backport is adopted by UK Core, the location of samples, including interactions to manage and track samples, will be performed through changes to Task resources generated on submission of a ServiceRequest.

A diagram illustrating the links between resources is provided below (Duo Scenario)

Note: links from ServiceRequest.supportingInfo to samples collected after submission are pending further investigation

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Specimen UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
sampleCategoryI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
accessionIdentifierΣ0..1Identifier
statusS Σ ?!0..1codeBinding
typeS Σ0..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Substance | Location)
receivedTimeS Σ0..1dateTime
parentI0..*Reference(Specimen)
requestI0..*Reference(ServiceRequest)
id0..1string
specialHandlingI0..*Extension(CodeableConcept)
modifierExtensionΣ ?! I0..*Extension
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Patient | RelatedPerson)
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
collectedDateTimedateTime
collectedPeriodPeriod
durationΣ I0..1Duration
quantityI0..1SimpleQuantity
method0..1CodeableConcept
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(BodyStructure)
codingΣ0..*Coding
textΣ0..1string
fastingStatusCodeableConceptCodeableConcept
fastingStatusDurationDuration
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
description0..1string
procedure0..1CodeableConcept
additiveI0..*Reference(Substance)
timeDateTimedateTime
timePeriodPeriod
id0..1string
deviceR5I0..1Extension(Reference(UKCoreDevice))
locationR5I0..1Extension(Reference(UKCoreLocation))
modifierExtensionΣ ?! I0..*Extension
identifierΣ0..*Identifier
description0..1string
type0..1CodeableConceptBinding
capacityI0..1SimpleQuantity
specimenQuantityI0..1SimpleQuantity
additiveCodeableConceptCodeableConcept
additiveReferenceReference(Substance)
conditionΣ0..*CodeableConceptBinding
note0..*Annotation

Differential from Specimen

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
sampleCategoryI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
accessionIdentifierΣ0..1Identifier
statusS Σ ?!0..1codeBinding
typeS Σ0..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Substance | Location)
receivedTimeS Σ0..1dateTime
parentI0..*Reference(Specimen)
requestI0..*Reference(ServiceRequest)
id0..1string
specialHandlingI0..*Extension(CodeableConcept)
modifierExtensionΣ ?! I0..*Extension
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Patient | RelatedPerson)
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
collectedDateTimedateTime
collectedPeriodPeriod
durationΣ I0..1Duration
quantityI0..1SimpleQuantity
method0..1CodeableConcept
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(BodyStructure)
codingΣ0..*Coding
textΣ0..1string
fastingStatusCodeableConceptCodeableConcept
fastingStatusDurationDuration
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
description0..1string
procedure0..1CodeableConcept
additiveI0..*Reference(Substance)
timeDateTimedateTime
timePeriodPeriod
id0..1string
deviceR5I0..1Extension(Reference(UKCoreDevice))
locationR5I0..1Extension(Reference(UKCoreLocation))
modifierExtensionΣ ?! I0..*Extension
identifierΣ0..*Identifier
description0..1string
type0..1CodeableConceptBinding
capacityI0..1SimpleQuantity
specimenQuantityI0..1SimpleQuantity
additiveCodeableConceptCodeableConcept
additiveReferenceReference(Substance)
conditionΣ0..*CodeableConceptBinding
note0..*Annotation

Specimen
DefinitionA sample to be used for analysis.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: 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
    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()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • ukcore-spec-001: There SHALL be only one reference between `collection.collector` and the extension `collectionCollectorR5`
    collection.collector.reference.empty() or collection.collector.extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Specimen.collection.collector').empty()
Mappings
  • rim: Entity. Role, or Act
  • rim: Role[classCode=SPEC]
Specimen.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Specimen.meta
DefinitionThe 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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.implicitRules
DefinitionA 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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Specimen.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

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).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Specimen.text
DefinitionA 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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Specimen.contained
DefinitionThese 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.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

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.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Specimen.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.extension:sampleCategory
DefinitionThis extension allows the recording of the category of a sample for use within Genomics, whether it is a tumour or germline sample.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.modifierExtension
DefinitionMay 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
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.

Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.identifier
DefinitionId for specimen.
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: SPM-2
  • rim: .id
Specimen.accessionIdentifier
DefinitionThe identifier assigned by the lab when accessioning specimen(s). This is not necessarily the same as the specimen identifier, depending on local lab procedures.
Cardinality0...1
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: SPM-30 (v2.7+)
  • rim: .participation[typeCode=SBJ].act[classCode=ACSN, moodCode=EVN].id
Specimen.status
DefinitionThe availability of the specimen.
Cardinality0...1
Typecode
Binding

Codes providing the status/availability of a specimen.

SpecimenStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • v2: SPM-20
  • rim: status
Specimen.type
DefinitionThe kind of material that forms the specimen.
Cardinality0...1
TypeCodeableConcept
Binding

A code from the SNOMED CT UK Clinical Terminology coding system

UKCoreSpecimenType (preferred)
Must SupportTrue
SummaryTrue
Comments

The type can change the way that a specimen is handled and drives what kind of analyses can properly be performed on the specimen. It is frequently used in diagnostic work flow decision making systems.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.what[x]
  • v2: SPM-4 and possibly SPM-5
  • rim: .code
Specimen.subject
DefinitionWhere the specimen came from. This may be from patient(s), from a location (e.g., the source of an environmental sample), or a sampling of a substance or a device.
Cardinality0...1
TypeReference(Patient | Group | Device | Substance | Location)
Must SupportTrue
SummaryTrue
Requirements

Must know the subject context.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.subject[x]
  • rim: .scoper or .scoper.playsRole
  • w5: FiveWs.subject
Specimen.receivedTime
DefinitionTime when specimen was received for processing or testing.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.done[x]
  • v2: SPM-18
  • rim: .participation[typeCode=SBJ].act[code=SPCREC, moodCode=EVN].effectiveTime
Specimen.parent
DefinitionReference to the parent (source) specimen which is used when the specimen was either derived from or a component of another specimen.
Cardinality0...*
TypeReference(Specimen)
Comments

The parent specimen could be the source from which the current specimen is derived by some processing step (e.g. an aliquot or isolate or extracted nucleic acids from clinical samples) or one of many specimens that were combined to create a pooled sample.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .scoper (if parent) .player.scopesRole[classCode=SPEC].player (if child)
Specimen.request
DefinitionDetails concerning a service request that required a specimen to be collected.
Cardinality0...*
TypeReference(ServiceRequest)
Comments

The request may be explicit or implied such with a ServiceRequest that requires a blood draw.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.why[x]
  • v2: ORC? OBR-2/3?
  • rim: outboundRelationship[typeCode=FLFS].target
Specimen.collection
DefinitionDetails concerning the specimen collection.
Cardinality0...1
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: SPM-14
  • rim: .participation[typeCode=SBJ].act[classCode=SPECCOLLECT, moodCode=EVN]
Specimen.collection.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.extension:specialHandling
DefinitionSpecial handling during the collection, transport, or storage of the specimen.
Cardinality0...*
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.modifierExtension
DefinitionMay 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
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.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector
DefinitionPerson who collected the specimen.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.actor
  • v2: PRT
  • rim: .participation[typeCode=PFM].role
Specimen.collection.collector.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.collector.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5
DefinitionPerson who collected the specimen. This is an R5 backport
Cardinality0...1
TypeExtension(Reference(Patient | RelatedPerson))
Aliasextensions, user content
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.collector.extension:collectionCollectorR5.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-Specimen.collection.collector

Mappings
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeReference(Patient | RelatedPerson)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.reference
DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality0...1
Typestring
SummaryTrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.type
DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality0...1
Typeuri
Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)
SummaryTrue
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.identifier
DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Cardinality0...1
TypeIdentifier
SummaryTrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • rim: .identifier
Specimen.collection.collector.display
DefinitionPlain text narrative that identifies the resource in addition to the resource reference.
Cardinality0...1
Typestring
SummaryTrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collected[x]
DefinitionTime when specimen was collected from subject - the physiologically relevant time.
Cardinality0...1
TypedateTime
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.init
  • v2: SPM-17
  • rim: .effectiveTime
Specimen.collection.duration
DefinitionThe span of time over which the collection of a specimen occurred.
Cardinality0...1
TypeDuration
SummaryTrue
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • w5: FiveWs.init
Specimen.collection.quantity
DefinitionThe quantity of specimen collected; for instance the volume of a blood sample, or the physical measurement of an anatomic pathology sample.
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: SPM-12
  • rim: .participation[typeCode=SBJ].role[classCode=SPEC].player.quantity
Specimen.collection.method
DefinitionA coded value specifying the technique that is used to perform the procedure.
Cardinality0...1
TypeCodeableConcept
Binding

The technique that is used to perform the procedure.

FHIRSpecimenCollectionMethod (example)
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-7
  • rim: .methodCode
Specimen.collection.bodySite
DefinitionAnatomical location from which the specimen was collected (if subject is a patient). This is the target site. This element is not used for environmental specimens.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing anatomical locations. May include laterality.

UKCoreSpecimenBodySite (preferred)
Comments

If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension bodySite.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-8 and SPM-9
  • rim: .targetSiteCode
Specimen.collection.bodySite.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.bodySite.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference
DefinitionAn extension to replicate the changes within R5 altering the data type of Specimen.collection.bodySite from CodeableConcept to CodeableReference (bodyStructure).
Cardinality0...1
TypeExtension(Reference(BodyStructure))
Aliasextensions, user content
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.bodySite.extension:bodySiteReference.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BodySiteReference

Mappings
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeReference(BodyStructure)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.coding
DefinitionA reference to a code defined by a terminology system.
Cardinality0...*
TypeCoding
SummaryTrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • v2: C*E.1-8, C*E.10-22
  • rim: union(., ./translation)
  • orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Specimen.collection.bodySite.text
DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Cardinality0...1
Typestring
SummaryTrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: C*E.9. But note many systems use C*E.2 for this
  • rim: ./originalText[mediaType/code="text/plain"]/data
  • orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Specimen.collection.fastingStatus[x]
DefinitionAbstinence or reduction from some or all food, drink, or both, for a period of time prior to sample collection.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing the fasting status of the patient.

v2.0916 (extensible)
SummaryTrue
Requirements

Many diagnostic tests require fasting to facilitate accurate interpretation.

Comments

Representing fasting status using this element is preferred to representing it with an observation using a 'pre-coordinated code' such as LOINC 2005-7 (Calcium [Moles/​time] in 2 hour Urine --12 hours fasting), or using a component observation such asObservation.component code` = LOINC 49541-6 (Fasting status - Reported).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: OBR-
Specimen.processing
DefinitionDetails concerning processing and processing steps for the specimen.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .participation[typeCode=SBJ].act[code=SPCTRT, moodCode=EVN]
Specimen.processing.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.processing.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.processing.modifierExtension
DefinitionMay 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
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.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.processing.description
DefinitionTextual description of procedure.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .text
Specimen.processing.procedure
DefinitionA coded value specifying the procedure used to process the specimen.
Cardinality0...1
TypeCodeableConcept
Binding

Type indicating the technique used to process the specimen.

SpecimenProcessingProcedure (example)
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .code
Specimen.processing.additive
DefinitionMaterial used in the processing step.
Cardinality0...*
TypeReference(Substance)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: SPM-6
  • rim: .participation[typeCode=CSM].role[classCode=ADTV].code
Specimen.processing.time[x]
DefinitionA record of the time or period when the specimen processing occurred. For example the time of sample fixation or the period of time the sample was in formalin.
Cardinality0...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
Specimen.container
DefinitionThe container holding the specimen. The recursive nature of containers; i.e. blood in tube in tray in rack is not addressed here.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .player.scopingRole[classCode=CONT].scoper
Specimen.container.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.container.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.extension:deviceR5
DefinitionThe device resource for the the container holding the specimen. If the container is in a holder then the referenced device will point to a parent device.
Cardinality0...1
TypeExtension(Reference(UKCoreDevice))
Aliasextensions, user content
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.extension:locationR5
DefinitionThe location of the container holding the specimen.
Cardinality0...1
TypeExtension(Reference(UKCoreLocation))
Aliasextensions, user content
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.modifierExtension
DefinitionMay 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
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.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.identifier
DefinitionId for container. There may be multiple; a manufacturer's bar code, lab assigned identifier, etc. The container ID may differ from the specimen id in some circumstances.
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • v2: SAC-3
  • rim: .id
Specimen.container.description
DefinitionTextual description of the container.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .desc
Specimen.container.type
DefinitionThe type of container associated with the specimen (e.g. slide, aliquot, etc.).
Cardinality0...1
TypeCodeableConcept
Binding

Type of specimen container.

SpecimenContainerType (preferred)
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-27
  • rim: .code
Specimen.container.capacity
DefinitionThe capacity (volume or other measure) the container may contain.
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: one of: SAC 16, SAC17 and SAC 20, or SAC 21 and SAC 20
  • rim: .quantity
Specimen.container.specimenQuantity
DefinitionThe quantity of specimen in the container; may be volume, dimensions, or other appropriate measurements, depending on the specimen type.
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: SAC-23 (value) SAC-24 (units
  • rim: .playedRole[classCode=CONT].quantity
Specimen.container.additive[x]
DefinitionIntroduced substance to preserve, maintain or enhance the specimen. Examples: Formalin, Citrate, EDTA.
Cardinality0...1
TypeCodeableConcept
Binding

Substance added to specimen container.

v2.0371 (example)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: SAC-27
  • rim: .scopesRole[classCode=ADTV].player
Specimen.condition
DefinitionA mode or state of being that describes the nature of the specimen.
Cardinality0...*
TypeCodeableConcept
Binding

Codes describing the state of the specimen.

UKCoreBiopsyState (extensible)
SummaryTrue
Requirements

The specimen condition can be used to assess its quality or appropriateness for a specific test.

Comments

Specimen condition is an observation made about the specimen. It's a point-in-time assessment. It can be used to assess its quality or appropriateness for a specific test.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-24
Specimen.note
DefinitionTo communicate any details or issues about the specimen or during the specimen collection. (for example: broken vial, sent with patient, frozen).
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • v2: OBX
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value


FHIRMDSHL7v2
SpecimenSample/Biopsy inc germline, Extracted SpecimenSPM
Specimen.subjectFetus - Is sample for fetal or unregistered neonate, Raw specimen/biopsy - Family member provided byPID segment attached to SPM
Specimen.collection.quantityPLCM activity - Sample volume, Raw specimen/biopsy - VolumeSPM-12
Specimen.typePLCM activity - Sample category codeSPM-4
Specimen.identifier.assignerRaw specimen/biopsy - Id assigning authority ODS code (many), Raw specimen/biopsy - Is assigning authority a histopathology laboratory (many), Extracted specimen - Id assigning authority ODS code (many)SPM-2.1.2
Specimen.identifier.valueRaw specimen/biopsy - Id (many), Extracted specimen - Id (many)SPM-2
Specimen.container.identifierRaw specimen/biopsy - Sample well identifierSAC-3
Specimen.noteRaw specimen/biopsy - Location details (will use backported R5 container.location once released), Extracted specimen - Location details, Raw specimen/biopsy - Sample to follow reason, Raw specimen/biopsy - Additional specimen/biopsy information, Extracted specimen - Additional specimen informationSAC-15, NTE segment attached to ORC, OBX segments attached to SPM
Specimen.extension:sampleCategoryRaw specimen/biopsy - WGS specimen type categorySPM-5
Specimen.typeRaw specimen/biopsy - Type, Raw specimen/biopsy - Blood component, Extracted specimen - TypeSPM-4
Specimen.conditionRaw specimen/biopsy - StateSPM-24
Specimen.processingRaw specimen/biopsy - Sample preparation (submitted to GLH)Combination of SPM-6/SPM-24 or NTE segments if other processing
Specimen.collection.collectedDateTimeRaw specimen/biopsy - Obtained dateSPM-17
Specimen.receivedTimeRaw specimen/biopsy - Received dateSPM-18
Specimen.collection.extension:specimen-specialHandling.valueCoding.codeRaw specimen/biopsy - High risk reason, Raw specimen/biopsy - Option for products of conceptionSPM-16.2, SPM-15
Specimen.collection.bodySiteRaw specimen/biopsy - Biopsy siteSPM-8/SPM-9
Specimen.statusRaw specimen/biopsy - Sample to followN/A implied through absence of SPM segment in test order
Specimen.conditionExtracted specimen - StateSPM-24
Specimen.processing.timeDateTimeExtracted specimen - Extracted dateOBR-7 attached to processing procedure in SAC-30

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Specimen_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Specimen-Genomics

Additional Guidance

extension:sampleCategory

Allows the categorisation of a sample into either tumour or germline. Additional terms may be added upon review though the valueCodeableConcept.text field MAY be used as a free text representation if needed.

"extension": [
        {
            "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-SampleCategory",
            "valueCodeableConcept": {
                "coding": [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-SampleCategory",
                        "code": "germline",
                        "display": "Germline"
                    }
                ]
            }
        }
    ]

identifier

Multiple identifiers MAY be assigned to a sample as it travels between labs. Each lab SHOULD append their local identifier to the identifier array if needed, ensuring either the system or assigner, is able to disambiguate any identifiers from possibly overlapping numbers from other organizations. Assigner is preferred in this case (see identifier example on the Genomics-Patient page for further guidance)

Note: accessionIdentifier is unused by the Genomic Medicine Service to facilitate movement of samples across organizational boundaries.

"identifier":  [
        {
            "system": "https://fhir.add.nhs.uk/Id/specimenId",
            "value": "RGT03135"
        }
    ],

status

If a Specimen has not been collected, the status SHOULD be marked as 'unavailable'. If the quality of the Specimen is such that it cannot be processed, the status SHOULD be 'unsatisfactory' (this is equivalent to a QC status of Failed). If the Specimen passes quality control, the status SHOULD be set as 'available

"status": "unsatisfactory",

type

The sample type, SNOMED CT preferred. Used to differentiate between raw and extracted (DNA) samples.

ConceptMaps for the allowed values for primary (raw) and final (extracted DNA) samples upon release of MDSv1.04, to aid identification of whether a sample is primary vs. final

"type": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "445295009",
                "display": "Blood specimen with EDTA"
            }
        ]
    },

subject

SHALL be provided. This SHOULD be a reference to the Patient resource or the identifier, NHS number, for the patient.

Samples collected from a Fetus SHOULD reference a Patient resource for the Fetus. This should then be linked to relevant maternal/paternal resources through the RelatedPerson resource. Further information can be found on the Fetus Management clinical scenario. It is not envisaged that samples would need to be linked to more than one person e.g. both fetus and mother, though this assumption will be tested within the Alpha phase of the Genomic Medicine Service.

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

receivedTime

SHOULD be updated upon receipt at a destination lab

"receivedTime": "2023-09-18T18:30:00Z"

parent

If a sample has been split into multiple parts, such as DNA being extracted from a primary sample, each SHOULD be represented using an additional Specimen resource, referencing the parent sample through the parent element.

The central Order Management broker will only create Tasks for Specimen resources which do not have a parent element, i.e. primary samples. If required, clients can create Tasks for processing of derivative samples manually.

"parent": [
        {
            "reference": "Specimen/Specimen-BloodEDTA-Example"
        }
    ],

request

SHALL be provided. This SHOULD be a reference to the request which initiated collection of the sample. SHALL NOT be updated if the sample is used for another test e.g. for re-analysis. In the case that a Specimen needs to be processed as part of a new request, e.g. using a sample in storage,the ServiceRequest SHALL reference the pre-existing sample via ServiceRequest.specimen.

"request":  [
        {
            "reference": "ServiceRequest/ServiceRequest-NonWGSTestOrderForm-Example"
        }
    ]

collection

Additional information which can be collected about the circumstances under which as sample was collected, if relevant. This include extensions for specialHandling of the sample, e.g. due to high risk of infection, as well as an extension to bodySite to extend the coding to a BodyStructure reference, for more detailed collection of structural information e.g. where tumour morphology and topography need to be collected.

Where the collector is an Organization, or where the individual is not known, ODS codes MAY be used as identifiers in place of SDS-User-IDs. However, if referencing a resource, the PractitionerRole resource SHOULD still be referenced. In this case the PractitionerRole.identifier and PractitionerRole.practitioner reference would not be filled, leaving only the reference to an Organization from PractitionerRole.organization.

Note on quanitities

The Specimen.collection.quantity is the amount of the sample collected at collection time. This quantity does not change as the sample is processed.

The Specimen.container.specimenQuantity is the amount of sample remaining in a container, this is equivalent to GEL 1001 banked volume. This value should be updated as the specimen is used.

If a specimen is split, additional specimen resources SHOULD be created (referencing the parent specimen), with individual container.specimenQuantity values.

"collection": {
        "collector": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/sds-user-id",
                "value": "999999"
            }
        },
        "collectedDateTime": "2022-07-11T09:00:00Z",
        "quantity": {
            "system": "http://unitsofmeasure.org",
            "code": "mL",
            "value": 2.5
        },
        "method": {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "129300006",
                    "display": "Puncture - action"
                }
            ]
        },
        "bodySite": {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "14975008",
                    "display": "Forearm structure (body structure)"
                }
            ]
        }
    },

processing

SHOULD be updated if processing occurs on the sample which affects later use, e.g. additives added

"processing": [
    {
      "description": "Acidify to pH < 3.0 with 6 N HCl.",
      "procedure": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0373",
            "code": "ACID"
          }
        ]
      },
      "additive": [
        {
          "display": "6 N HCl"
        }
      ],
      "timeDateTime": "2015-08-18T08:10:00Z"
    }
  ],

container

The UK Core STU3 version of Specimen backports the R5 changes to the container BackboneElement to support capturing of storage location for a sample (through container.location) and recursive capture of device identifiers (e.g. tube, well, rack, freezer through container.device).

Additional examples/guidance will be provided within this IG once use of the fields has been appropriately tested.

Sample tracking information SHOULD be added to Tasks acting on Specimen resources, e.g. Tasks marked SamplePreparation or SampleProcessing, on either the output or input elements. This information MAY include consignment number, destination, date sent etc.

"container":  [
        {
            "extension":  [
                {
                    "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Specimen.container.location",
                    "valueReference": {
                            "reference": "Location/Location-NTGLHFridge-Example"
                    }
                }
            ]
        }
    ]

condition

Used to record the condition of a specimen. Within Genomics, SHOULD be used to record the fixed/frozen state, using the UK Core bound ValueSet.

"condition":  [
        {
            "coding":  [
                {
                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-BiopsyState",
                    "code": "fresh-frozen",
                    "display": "Fresh Frozen"
                }
            ]
        }
    ]