WARNING
This guidance is under active development by NHS England and content may be added or updated on a regular basis. The implementation guide is currently in draft and SHOULD NOT be used for development or implementation without consulting the NHS England Pathology Standards and Implementation team.PATH-R4-02: Bundle Example - Haemoglobin A1c (HbA1c) Report
- This is an example of a report that contains a single test result.
- The test result is defined as an
Observationand is referenced fromDiagnosticReportusingDiagnosticReport.result. - The test result type is numeric and is specified using
Observation.valueQuantity. - Detailed narrative-based reference range information for the test result is carried in
Observation.referenceRange.text.
The following is a simplified logical data model that illustrates the key references between the FHIR profiles in the example message bundle. To aid clarity, not all of the references are shown. For a detailed description of the relationships between the FHIR profiles, and how they may be used, refer to How to Construct a Pathology Test Report Bundle.
<Bundle xmlns="http://hl7.org/fhir"> <id value="Pathology-Bundle-HbA1c-Report-Example" /> <meta> <lastUpdated value="2022-01-30T12:48:00+00:00" /> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle" /> </meta> <identifier> <system value="https://tools.ietf.org/html/rfc4122" /> <value value="82a908e2-f8fe-4ea4-a651-9758588304fd" /> </identifier> <type value="message" /> <entry> <fullUrl value="urn:uuid:f18a2226-c0ab-480d-b80a-b6561fe8f9c4" /> <resource> <MessageHeader> <!-- TBC Review content of MessageHeader --> <id value="f18a2226-c0ab-480d-b80a-b6561fe8f9c4" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MessageHeader" /> </meta> <eventCoding> <system value="http://snomed.info/sct" /> <code value="371528001" /> <display value="Pathology report" /> </eventCoding> <destination> <name value="PICKERING MEDICAL PRACTICE" /> <!-- TBC Update endpoint address --> <endpoint value="TBC" /> <!-- Requesting Organisation --> <receiver> <reference value="urn:uuid:3c43b5b3-06d6-445f-ae9a-48d5f05df434" /> </receiver> </destination> <sender> <!-- Performing Laboratory --> <reference value="urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338" /> </sender> <source> <!-- TBC Update endpoint address --> <endpoint value="TBC" /> </source> <focus> <!-- DiagnosticReport --> <reference value="urn:uuid:35d46ca1-f253-4c97-b7ee-fb5fccdf6c20" /> </focus> <definition value="https://fhir.nhs.uk/England/MessageDefinition/England-Pathology-Report" /> </MessageHeader> </resource> </entry> <entry> <fullUrl value="urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338" /> <resource> <Organization> <!-- Performing Laboratory --> <id value="8a6d85b8-9837-4fed-a257-4cf207988338" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" /> </meta> <identifier> <system value="https://fhir.nhs.uk/Id/ods-organization-code" /> <value value="Y8J7D" /> </identifier> <name value="TD008362 PATH LAB 001" /> <address> <line value="PATHOLOGY LAB" /> <line value="7-8 WELLINGTON PLACE" /> <city value="LEEDS" /> <district value="WEST YORKSHIRE" /> <postalCode value="LS1 4AP" /> </address> </Organization> </resource> </entry> <entry> <fullUrl value="urn:uuid:3c43b5b3-06d6-445f-ae9a-48d5f05df434" /> <resource> <Organization> <!-- Requesting Organisation --> <id value="3c43b5b3-06d6-445f-ae9a-48d5f05df434" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" /> </meta> <identifier> <system value="https://fhir.nhs.uk/Id/ods-organization-code" /> <value value="B82033" /> </identifier> <name value="PICKERING MEDICAL PRACTICE" /> <address> <line value="SOUTHGATE" /> <city value="PICKERING" /> <district value="NORTH YORKSHIRE" /> <postalCode value="YO18 8BL" /> </address> </Organization> </resource> </entry> <entry> <fullUrl value="urn:uuid:9a835acf-d715-4d84-8dcf-a8435f6417fe" /> <resource> <Practitioner> <!-- Requesting Practitioner --> <id value="9a835acf-d715-4d84-8dcf-a8435f6417fe" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" /> </meta> <identifier> <system value="https://fhir.hl7.org.uk/Id/gmc-number" /> <value value="C1008215" /> </identifier> <name> <use value="official" /> <family value="GASKELL" /> <given value="Gale" /> <prefix value="Dr" /> </name> </Practitioner> </resource> </entry> <entry> <fullUrl value="urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4" /> <resource> <Patient> <id value="ab87a3f8-1d37-44a9-804e-5e962598a6e4" /> <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-NHSNumberVerificationStatusEngland" /> <code value="01" /> <display value="Number present and verified" /> </coding> </valueCodeableConcept> </extension> <system value="https://fhir.nhs.uk/Id/nhs-number" /> <value value="9727710638" /> </identifier> <name> <use value="official" /> <family value="WELSH" /> <given value="Joel" /> </name> <gender value="male" /> <birthDate value="1972-08-23" /> <address> <line value="ACONBURY" /> <line value="LARPOOL DRIVE" /> <city value="WHITBY" /> <postalCode value="YO22 4ND" /> </address> </Patient> </resource> </entry> <entry> <fullUrl value="urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac" /> <resource> <ServiceRequest> <id value="1c38d507-9ad7-4b49-ba91-7da204842cac" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-ServiceRequest-Lab" /> </meta> <identifier> <system value="http://B82033-pickeringmedicalpractice.com/labrequest" /> <value value="REQ-20220129-000241" /> </identifier> <status value="active" /> <intent value="order" /> <code> <coding> <!-- From PaLM procedure reference set --> <system value="http://snomed.info/sct" /> <code value="43396009" /> <display value="Haemoglobin A1c measurement" /> </coding> </code> <subject> <reference value="urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4" /> <display value="WELSH, Joel" /> </subject> <authoredOn value="2022-01-29T10:24:00+00:00" /> <requester> <reference value="urn:uuid:9a835acf-d715-4d84-8dcf-a8435f6417fe" /> <display value="GASKELL, Dr Gale" /> </requester> <performer> <reference value="urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338" /> <display value="TD008362 PATH LAB 001" /> </performer> <specimen> <reference value="urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d" /> </specimen> </ServiceRequest> </resource> </entry> <entry> <fullUrl value="urn:uuid:35d46ca1-f253-4c97-b7ee-fb5fccdf6c20" /> <resource> <DiagnosticReport> <id value="35d46ca1-f253-4c97-b7ee-fb5fccdf6c20" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-DiagnosticReport-Lab" /> </meta> <identifier> <system value="http://Y8J7D-pathlab001.com/report" /> <value value="REP-20220130-007843" /> </identifier> <basedOn> <reference value="urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac" /> </basedOn> <status value="final" /> <category> <coding> <system value="http://terminology.hl7.org/CodeSystem/v2-0074" /> <code value="LAB" /> <display value="Laboratory" /> </coding> </category> <code> <coding> <system value="http://snomed.info/sct" /> <code value="721981007" /> <display value="Diagnostic studies report" /> </coding> </code> <subject> <reference value="urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4" /> <display value="WELSH, Joel" /> </subject> <issued value="2022-01-30T12:48:00+00:00" /> <performer> <reference value="urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338" /> <display value="TD008362 PATH LAB 001" /> </performer> <specimen> <reference value="urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d" /> </specimen> <result> <reference value="urn:uuid:ad717ae8-cb35-4d66-ba51-e22a76b1d158" /> </result> </DiagnosticReport> </resource> </entry> <entry> <fullUrl value="urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d" /> <resource> <Specimen> <id value="bab0eaec-1ec5-4598-b660-90bb38a1030d" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Specimen" /> </meta> <identifier> <system value="http://B82033-pickeringmedicalpractice.com/specimen" /> <value value="SPC-REQ-20220129-000362" /> </identifier> <accessionIdentifier> <system value="http://Y8J7D-pathlab001.com/specimen" /> <value value="SPC-LAB-20220129-008927" /> </accessionIdentifier> <status value="available" /> <type> <coding> <system value="http://snomed.info/sct" /> <code value="122555007" /> <display value="Venous blood specimen" /> </coding> </type> <subject> <reference value="urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4" /> <display value="WELSH, Joel" /> </subject> <receivedTime value="2022-01-29T15:14:00+00:00" /> <collection> <collectedDateTime value="2022-01-29T10:18:00+00:00" /> </collection> </Specimen> </resource> </entry> <entry> <fullUrl value="urn:uuid:ad717ae8-cb35-4d66-ba51-e22a76b1d158" /> <resource> <Observation> <id value="ad717ae8-cb35-4d66-ba51-e22a76b1d158" /> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab" /> </meta> <identifier> <system value="https://tools.ietf.org/html/rfc4122" /> <value value="2af46949-4938-4c57-bad4-c4363e1965d5" /> </identifier> <status value="final" /> <category> <coding> <system value="http://terminology.hl7.org/CodeSystem/observation-category" /> <code value="laboratory" /> <display value="Laboratory" /> </coding> </category> <code> <coding> <!-- From PBCL and PaLM observable entity reference sets --> <system value="http://snomed.info/sct" /> <code value="999791000000106" /> <display value="Haemoglobin A1c level - International Federation of Clinical Chemistry and Laboratory Medicine standardised" /> </coding> </code> <subject> <reference value="urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4" /> <display value="WELSH, Joel" /> </subject> <issued value="2022-01-30T12:48:00+00:00" /> <performer> <reference value="urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338" /> <display value="TD008362 PATH LAB 001" /> </performer> <valueQuantity> <value value="54" /> <unit value="mmol/mol" /> <system value="http://unitsofmeasure.org" /> <code value="mmol/mol" /> </valueQuantity> <specimen> <reference value="urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d" /> </specimen> <referenceRange> <text value="DIAGNOSIS OF DIABETES MELLITUS:\nHbA1c of 48 mmol/mol and above is diagnostic of DM (WHO 2011)\n42 - 47 mmol/mol indicates high risk of DM (NICE Guidance PH38 2012)\n\nMONITORING OF DIABETES MELLITUS (ADULTS):\nType 2 target values: 48 mmol/mol – 57 mmol/mol (NICE Guidelines NG28)\nType 1 target values: 48 mmol/mol or lower (NICE Guidelines NG17)" /> </referenceRange> </Observation> </resource> </entry> </Bundle>
{ "resourceType": "Bundle", "id": "Pathology-Bundle-HbA1c-Report-Example", "meta": { "lastUpdated": "2022-01-30T12:48:00+00:00", "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle" ] }, "identifier": { "system": "https://tools.ietf.org/html/rfc4122", "value": "82a908e2-f8fe-4ea4-a651-9758588304fd" }, "type": "message", "entry": [ { "fullUrl": "urn:uuid:f18a2226-c0ab-480d-b80a-b6561fe8f9c4", "resource": { "resourceType": "MessageHeader", "id": "f18a2226-c0ab-480d-b80a-b6561fe8f9c4", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MessageHeader" ] }, "eventCoding": { "system": "http://snomed.info/sct", "code": "371528001", "display": "Pathology report" }, "destination": [ { "name": "PICKERING MEDICAL PRACTICE", "endpoint": "TBC", "receiver": { "reference": "urn:uuid:3c43b5b3-06d6-445f-ae9a-48d5f05df434" } } ], "sender": { "reference": "urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338" }, "source": { "endpoint": "TBC" }, "focus": [ { "reference": "urn:uuid:35d46ca1-f253-4c97-b7ee-fb5fccdf6c20" } ], "definition": "https://fhir.nhs.uk/England/MessageDefinition/England-Pathology-Report" } }, { "fullUrl": "urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338", "resource": { "resourceType": "Organization", "id": "8a6d85b8-9837-4fed-a257-4cf207988338", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" ] }, "identifier": [ { "system": "https://fhir.nhs.uk/Id/ods-organization-code", "value": "Y8J7D" } ], "name": "TD008362 PATH LAB 001", "address": [ { "line": [ "PATHOLOGY LAB", "7-8 WELLINGTON PLACE" ], "city": "LEEDS", "district": "WEST YORKSHIRE", "postalCode": "LS1 4AP" } ] } }, { "fullUrl": "urn:uuid:3c43b5b3-06d6-445f-ae9a-48d5f05df434", "resource": { "resourceType": "Organization", "id": "3c43b5b3-06d6-445f-ae9a-48d5f05df434", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" ] }, "identifier": [ { "system": "https://fhir.nhs.uk/Id/ods-organization-code", "value": "B82033" } ], "name": "PICKERING MEDICAL PRACTICE", "address": [ { "line": [ "SOUTHGATE" ], "city": "PICKERING", "district": "NORTH YORKSHIRE", "postalCode": "YO18 8BL" } ] } }, { "fullUrl": "urn:uuid:9a835acf-d715-4d84-8dcf-a8435f6417fe", "resource": { "resourceType": "Practitioner", "id": "9a835acf-d715-4d84-8dcf-a8435f6417fe", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" ] }, "identifier": [ { "system": "https://fhir.hl7.org.uk/Id/gmc-number", "value": "C1008215" } ], "name": [ { "use": "official", "family": "GASKELL", "given": [ "Gale" ], "prefix": [ "Dr" ] } ] } }, { "fullUrl": "urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4", "resource": { "resourceType": "Patient", "id": "ab87a3f8-1d37-44a9-804e-5e962598a6e4", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" ] }, "identifier": [ { "extension": [ { "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus", "valueCodeableConcept": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-NHSNumberVerificationStatusEngland", "code": "01", "display": "Number present and verified" } ] } } ], "system": "https://fhir.nhs.uk/Id/nhs-number", "value": "9727710638" } ], "name": [ { "use": "official", "family": "WELSH", "given": [ "Joel" ] } ], "gender": "male", "birthDate": "1972-08-23", "address": [ { "line": [ "ACONBURY", "LARPOOL DRIVE" ], "city": "WHITBY", "postalCode": "YO22 4ND" } ] } }, { "fullUrl": "urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac", "resource": { "resourceType": "ServiceRequest", "id": "1c38d507-9ad7-4b49-ba91-7da204842cac", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-ServiceRequest-Lab" ] }, "identifier": [ { "system": "http://B82033-pickeringmedicalpractice.com/labrequest", "value": "REQ-20220129-000241" } ], "status": "active", "intent": "order", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "43396009", "display": "Haemoglobin A1c measurement" } ] }, "subject": { "reference": "urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4", "display": "WELSH, Joel" }, "authoredOn": "2022-01-29T10:24:00+00:00", "requester": { "reference": "urn:uuid:9a835acf-d715-4d84-8dcf-a8435f6417fe", "display": "GASKELL, Dr Gale" }, "performer": [ { "reference": "urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338", "display": "TD008362 PATH LAB 001" } ], "specimen": [ { "reference": "urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d" } ] } }, { "fullUrl": "urn:uuid:35d46ca1-f253-4c97-b7ee-fb5fccdf6c20", "resource": { "resourceType": "DiagnosticReport", "id": "35d46ca1-f253-4c97-b7ee-fb5fccdf6c20", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-DiagnosticReport-Lab" ] }, "identifier": [ { "system": "http://Y8J7D-pathlab001.com/report", "value": "REP-20220130-007843" } ], "basedOn": [ { "reference": "urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "721981007", "display": "Diagnostic studies report" } ] }, "subject": { "reference": "urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4", "display": "WELSH, Joel" }, "issued": "2022-01-30T12:48:00+00:00", "performer": [ { "reference": "urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338", "display": "TD008362 PATH LAB 001" } ], "specimen": [ { "reference": "urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d" } ], "result": [ { "reference": "urn:uuid:ad717ae8-cb35-4d66-ba51-e22a76b1d158" } ] } }, { "fullUrl": "urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d", "resource": { "resourceType": "Specimen", "id": "bab0eaec-1ec5-4598-b660-90bb38a1030d", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Specimen" ] }, "identifier": [ { "system": "http://B82033-pickeringmedicalpractice.com/specimen", "value": "SPC-REQ-20220129-000362" } ], "accessionIdentifier": { "system": "http://Y8J7D-pathlab001.com/specimen", "value": "SPC-LAB-20220129-008927" }, "status": "available", "type": { "coding": [ { "system": "http://snomed.info/sct", "code": "122555007", "display": "Venous blood specimen" } ] }, "subject": { "reference": "urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4", "display": "WELSH, Joel" }, "receivedTime": "2022-01-29T15:14:00+00:00", "collection": { "collectedDateTime": "2022-01-29T10:18:00+00:00" } } }, { "fullUrl": "urn:uuid:ad717ae8-cb35-4d66-ba51-e22a76b1d158", "resource": { "resourceType": "Observation", "id": "ad717ae8-cb35-4d66-ba51-e22a76b1d158", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab" ] }, "identifier": [ { "system": "https://tools.ietf.org/html/rfc4122", "value": "2af46949-4938-4c57-bad4-c4363e1965d5" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "999791000000106", "display": "Haemoglobin A1c level - International Federation of Clinical Chemistry and Laboratory Medicine standardised" } ] }, "subject": { "reference": "urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4", "display": "WELSH, Joel" }, "issued": "2022-01-30T12:48:00+00:00", "performer": [ { "reference": "urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338", "display": "TD008362 PATH LAB 001" } ], "valueQuantity": { "value": 54, "unit": "mmol/mol", "system": "http://unitsofmeasure.org", "code": "mmol/mol" }, "specimen": { "reference": "urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d" }, "referenceRange": [ { "text": "DIAGNOSIS OF DIABETES MELLITUS:\nHbA1c of 48 mmol/mol and above is diagnostic of DM (WHO 2011)\n42 - 47 mmol/mol indicates high risk of DM (NICE Guidance PH38 2012)\n\nMONITORING OF DIABETES MELLITUS (ADULTS):\nType 2 target values: 48 mmol/mol – 57 mmol/mol (NICE Guidelines NG28)\nType 1 target values: 48 mmol/mol or lower (NICE Guidelines NG17)" } ] } } ] }