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-R4-14: Bundle Example - Liver Function Tests and Urea and Electrolytes Report
- This is an example of a report that contains the results associated with multiple test groups.
- The test groups were requested as part of the same “event” (i.e. by the same practitioner at the same time for the same subject).
- An instance of
ServiceRequestis required for each requested test group. - Each
ServiceRequestwithin a set of related requests uses a common identifier,ServiceRequest.requisition, to link them together. For further information, refer to the description of the UKCore-ServiceRequest-Lab profile. - In this example, the specimen (venous blood) was collected after the request was made. The specimen is linked to the request within the
BundleusingSpecimen.request.
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>
</identifier>
<MessageHeader>
<!-- TBC Review content of MessageHeader -->
</meta>
</eventCoding>
<!-- TBC Update endpoint address -->
<!-- Requesting Organisation -->
</receiver>
</destination>
<!-- Performing Laboratory -->
</sender>
<!-- TBC Update endpoint address -->
</source>
<!-- DiagnosticReport -->
</focus>
</MessageHeader>
</resource>
</entry>
<Organization>
<!-- Performing Laboratory -->
</meta>
</identifier>
</address>
</Organization>
</resource>
</entry>
<Organization>
<!-- Requesting Organisation -->
</meta>
</identifier>
</address>
</Organization>
</resource>
</entry>
<Practitioner>
<!-- Requesting Practitioner -->
</meta>
</identifier>
</name>
</Practitioner>
</resource>
</entry>
<Patient>
</meta>
<extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus">
</coding>
</valueCodeableConcept>
</extension>
</identifier>
</name>
</address>
</Patient>
</resource>
</entry>
<ServiceRequest>
</meta>
</identifier>
</requisition>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</requester>
</performer>
</ServiceRequest>
</resource>
</entry>
<ServiceRequest>
</meta>
</identifier>
</requisition>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</requester>
</performer>
</ServiceRequest>
</resource>
</entry>
<DiagnosticReport>
</meta>
</identifier>
<!-- Hepatic function panel request -->
</basedOn>
<!-- Urea and electrolytes request -->
</basedOn>
</coding>
</category>
</coding>
</code>
</subject>
</performer>
</specimen>
<!-- Test group Observation for Hepatic function panel -->
</result>
<!-- Test group Observation for Urea and electrolytes -->
</result>
</DiagnosticReport>
</resource>
</entry>
<Specimen>
</meta>
</identifier>
</accessionIdentifier>
</coding>
</type>
</subject>
</request>
</collection>
</Specimen>
</resource>
</entry>
<Observation>
<!-- Test group Observation for Hepatic function panel -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</performer>
<!-- Total bilirubin substance concentration in serum -->
</hasMember>
<!-- Albumin mass concentration in serum -->
</hasMember>
<!-- Alkaline phosphatase enzyme activity in serum -->
</hasMember>
<!-- Alanine aminotransferase enzyme activity in serum -->
</hasMember>
</Observation>
</resource>
</entry>
<Observation>
<!-- Total bilirubin substance concentration in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- Albumin mass concentration in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</low>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- Alkaline phosphatase enzyme activity in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</low>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- Alanine aminotransferase enzyme activity in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- Test group Observation for Urea and electrolytes -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</performer>
<!-- Urea substance concentration in serum -->
</hasMember>
<!-- Sodium substance concentration in serum -->
</hasMember>
<!-- Potassium substance concentration in serum -->
</hasMember>
<!-- Creatinine substance concentration in serum -->
</hasMember>
<!-- eGFR (estimated glomerular filtration rate) using CKD-Epi -->
</hasMember>
</Observation>
</resource>
</entry>
<Observation>
<!-- Urea substance concentration in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</low>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- Sodium substance concentration in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</low>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- Potassium substance concentration in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</low>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- Creatinine substance concentration in serum -->
</meta>
</identifier>
</coding>
</category>
<!-- Equivalent codes from the PBCL and PaLM SNOMED CT reference sets are used in this example. -->
<!-- In practice, it is likely that only a code from one reference set will be carried. -->
<!-- From PBCL observable entity reference set -->
</coding>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</low>
</high>
</referenceRange>
</Observation>
</resource>
</entry>
<Observation>
<!-- eGFR (estimated glomerular filtration rate) using CKD-Epi -->
</meta>
</identifier>
</coding>
</category>
<!-- From PBCL and PaLM observable entity reference sets -->
<display value="eGFR (estimated glomerular filtration rate) using creatinine Chronic Kidney Disease Epidemiology Collaboration equation per 1.73 square metres" />
</coding>
</code>
</subject>
</performer>
</valueQuantity>
<text value="Calculated eGFR is not valid in children or pregnancy.\nLess accurate with acute change in creatinine (AKI).\nCaution with high or low muscle mass or amputation.\nAvoid blood sampling within 12 hours of eating meat.\nEthnicity factor comment removed Dec21 NG203." />
</note>
</specimen>
</Observation>
</resource>
</entry>
</Bundle>
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{
"PATHOLOGY LAB",
"7-8 WELLINGTON PLACE"
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{
"SOUTHGATE"
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"display": "eGFR (estimated glomerular filtration rate) using creatinine Chronic Kidney Disease Epidemiology Collaboration equation per 1.73 square metres"
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{
"text": "Calculated eGFR is not valid in children or pregnancy.\nLess accurate with acute change in creatinine (AKI).\nCaution with high or low muscle mass or amputation.\nAvoid blood sampling within 12 hours of eating meat.\nEthnicity factor comment removed Dec21 NG203."
}
],
}
}
}
]
}
| Bundle |
| id : Pathology-Bundle-LFT-UandE-Report-Example |
| meta |
| lastUpdated : 2022-03-08T14:23:00+00:00 |
| profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle |
| identifier |
| system : https://tools.ietf.org/html/rfc4122 |
| value : d8d2d20e-8c44-466d-8640-7a516db7cd27 |
| type : message |
| entry |
| fullUrl : urn:uuid:f18a2226-c0ab-480d-b80a-b6561fe8f9c4 |
| resource |
| id : f18a2226-c0ab-480d-b80a-b6561fe8f9c4 |
| meta |
| profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-MessageHeader |
| event |
| 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 |
| entry |
| fullUrl : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
| resource |
| 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 |
| line : 7-8 WELLINGTON PLACE |
| city : LEEDS |
| district : WEST YORKSHIRE |
| postalCode : LS1 4AP |
| entry |
| fullUrl : urn:uuid:3c43b5b3-06d6-445f-ae9a-48d5f05df434 |
| resource |
| 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 |
| entry |
| fullUrl : urn:uuid:9a835acf-d715-4d84-8dcf-a8435f6417fe |
| resource |
| 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 |
| entry |
| fullUrl : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
| resource |
| 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 |
| value |
| 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 |
| line : LARPOOL DRIVE |
| district : NORTH YORKSHIRE |
| postalCode : YO22 4ND |
| entry |
| fullUrl : urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac |
| resource |
| 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-20220307-000046-001 |
| requisition |
| system : http://B82033-pickeringmedicalpractice.com/labrequest |
| value : REQ-20220307-000046 |
| status : active |
| intent : order |
| code |
| coding |
| system : http://snomed.info/sct |
| code : 26958001 |
| display : Hepatic function panel |
| subject |
| reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
| display : WELSH, Joel |
| authoredOn : 2022-03-07T09:48:00+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 |
| entry |
| fullUrl : urn:uuid:8660ef6a-65ef-408f-92ce-b4d6d03d783c |
| resource |
| id : 8660ef6a-65ef-408f-92ce-b4d6d03d783c |
| meta |
| profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-ServiceRequest-Lab |
| identifier |
| system : http://B82033-pickeringmedicalpractice.com/labrequest |
| value : REQ-20220307-000046-002 |
| requisition |
| system : http://B82033-pickeringmedicalpractice.com/labrequest |
| value : REQ-20220307-000046 |
| status : active |
| intent : order |
| code |
| coding |
| system : http://snomed.info/sct |
| code : 252167001 |
| display : Urea and electrolytes |
| subject |
| reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
| display : WELSH, Joel |
| authoredOn : 2022-03-07T09:48:00+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 |
| entry |
| fullUrl : urn:uuid:35d46ca1-f253-4c97-b7ee-fb5fccdf6c20 |
| resource |
| 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-20220308-008902 |
| basedOn |
| reference : urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac |
| basedOn |
| reference : urn:uuid:8660ef6a-65ef-408f-92ce-b4d6d03d783c |
| 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 : 2022-03-08T14:23:00+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:33a88119-6dbc-4bdf-809a-c1d822b74e90 |
| result |
| reference : urn:uuid:a5c7f5e2-eb95-469b-b588-f7861c260ccb |
| entry |
| fullUrl : urn:uuid:bab0eaec-1ec5-4598-b660-90bb38a1030d |
| resource |
| 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-20220307-000014 |
| accessionIdentifier |
| system : http://Y8J7D-pathlab001.com/specimen |
| value : SPC-Lab-20220307-007856 |
| 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 : 2022-03-07T14:54:00+00:00 |
| request |
| reference : urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac |
| collection |
| collected : 2022-03-07T10:02:00+00:00 |
| entry |
| fullUrl : urn:uuid:33a88119-6dbc-4bdf-809a-c1d822b74e90 |
| resource |
| id : 33a88119-6dbc-4bdf-809a-c1d822b74e90 |
| meta |
| profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab |
| identifier |
| system : https://tools.ietf.org/html/rfc4122 |
| value : 9920b5d3-9f19-41df-8d5a-fd2d4288e305 |
| status : final |
| category |
| coding |
| system : http://terminology.hl7.org/CodeSystem/observation-category |
| code : laboratory |
| display : Laboratory |
| code |
| coding |
| system : http://snomed.info/sct |
| code : 26958001 |
| display : Hepatic function panel |
| subject |
| reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
| display : WELSH, Joel |
| issued : 2022-03-08T14:23:00+00:00 |
| performer |
| reference : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
| display : TD008362 PATH LAB 001 |
| hasMember |
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| text : Calculated eGFR is not valid in children or pregnancy. Less accurate with acute change in creatinine (AKI). Caution with high or low muscle mass or amputation. Avoid blood sampling within 12 hours of eating meat. Ethnicity factor comment removed Dec21 NG203. |
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| Bundle.entry[19].resource[0].value[0].code[0] | mL/min/((173/100).m2) |
| Bundle.entry[19].resource[0].note[0].text[0] | Calculated eGFR is not valid in children or pregnancy. Less accurate with acute change in creatinine (AKI). Caution with high or low muscle mass or amputation. Avoid blood sampling within 12 hours of eating meat. Ethnicity factor comment removed Dec21 NG203. |
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