Important: All content in this FHIR Implementation Guide is under development

Diagnostic Report Guidance

Introduction

This page describes how the DataStandardsWales DiagnosticReport profile supports the following types of reports that would be returned against a patient within NHS Wales. The following are expected use cases for the DataStandardsWales DiagnosticReport profile:

  • Laboratory result(s)
  • An imaging study report
  • A diagnostic report where the result is contained within an attached document (PDF or similar)

This implementation guidance includes the following profiles for diagnostic data:

Clinical Scenario: Laboratory/Pathology Result

Overview

Pathology is the most prevalent of the results in the Welsh Results & Reporting Service. Pathology covers many departmental areas:

  • Blood Sciences (BSC)
  • Bio-Chemistry (CHM)
  • Immunology (IMM)
  • Microbiology MIC)
  • Histopathology (HIS)
  • Haematology
  • Screening
  • Andrology

Implementation Guidance

Please refer to the Data Standards Wales DiagnosticReport for Laboratory Results Profile page for general guidance.

For Pathology results in NHS Wales:

  • The DiagnosticReport.meta.profile field SHALL be https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-DiagnosticReport-Lab

  • The DiagnosticReport.result field SHALL be populated
    • This field will be populated with the Observation Group containing 1 or multiple ObservationResults as Members.

Scenario 1: Single Panel

  • Status: Final
  • Security Label: Normal
  • Category: Pathology
  • Code: FBC
  • Result: FBC (Full Blood Count)

Logical Model

The diagram below shows the typical relationship between NHS Wales DiagnosticReport and Observations.


Important: Single panel approach for Laboratory DiagnosticReports needs review and approval.

Example Result

Click here for an Example of a Diagnostic Report returning Pathology single panel Full Blood Count Blood Sciences result.

Scenario 2: Multiple Panel

  • Status: Final
  • Security Label: Normal
  • Category: Pathology
  • Code: Pathology
  • Results: ACE (Angiotensin Converting Enzyme), LFT (Liver Function Test)

Logical Model

The diagram below shows the typical relationship between NHS Wales DiagnosticReport and Observations.


Click here for an Example of a Diagnostic Report returning Pathology multiple panel Blood Sciences result.

Overview

Radiology Imaging results can include the following types

  • X-Rays
  • Computed Tomography (CT)
  • Magnetic Resonance Tomography (MRI)
  • Nuclear Medicine Positron Emission Tomography (PET)
  • Ultrasound

Implementation Guidance

Please refer to the DataStandardsWales-DiagnosticReport Profile page for general guidance.

For Radiology Imaging results in NHS Wales:

  • The DiagnosticReport.meta.profile field SHALL be https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-DiagnosticReport

  • The DiagnosticReport.imagingStudy field SHALL be populated

Scenario

  • Status: Final
  • Security Label: Normal
  • Category: Radiology
  • Code: CT Abdomen

Logical Model

The diagram below shows the typical relationship between NHS Wales DiagnosticReport and Imaging .


Example Results

  • Click here for an example of a Diagnostic Report returning a CT Abdomen ImagingStudy reference.
  • Click here for an example of the referenced ImagingStudy.
  • Click here for an example of the referenced FHIR Endpoint.

Clinical Scenario: Cardiology Result (Attached Document)

Overview

Departments that can send binary attachments within NHS Wales to the Welsh Results & Reporting Service system are:

  • Blood Science
  • Cardiology
  • Endoscopy
  • Genetics
  • Haematology
  • Histology
  • Microbiology
  • Neurophysiology
  • Radiology
  • Respiratory
  • Urology

Implementation Guidance

Please refer to the DataStandardsWales-DiagnosticReport Profile page for general guidance.

For DiagnosticReport results with Attached Documents in NHS Wales:

  • The DiagnosticReport.meta.profile field SHALL be https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-DiagnosticReport

  • The DiagnosticReport.presentedForm field SHALL be populated
    • The DiagnosticReport.presentedForm.contentType field SHALL be populated
    • The DiagnosticReport.presentedForm.data field SHALL be populated with base64 string representation of the document
    • The DiagnosticReport.presentedForm.title field SHALL be populated

Scenario 1

  • Status: Final
  • Security Label: Normal
  • Category: Cardiology
  • Encounter: Emergency Admission
  • Result: ECG

Logical Model

The diagram below shows the typical relationship between NHS Wales DiagnosticReport and presentedForm .


Example Result

Click here for an Example of a Diagnostic Report returning a Cardiology ECG report as presentedForm.

Scenario 2

  • Status: Final
  • Security Label: Normal
  • Category: Cardiology
  • Result: Stress Test

Example Result

Click here for an Example of a Diagnostic Report returning a Cardiology Stress Test report as presentedForm.