Pathology FHIR Implementation Guide

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 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 Observation and is referenced from DiagnosticReport using DiagnosticReport.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

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<meta>

</meta>

</identifier>

<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": {

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