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-R4-18b: Bundle Example - Urine Microscopy, Culture and Sensitivity Report (Structured)
- This is an example of a complex report.
- The results are represented using a set of structured, coded
Observations
. - It contains multiple levels of test group
Observations
and test resultObservations
. Two of the test groups are nested ("Urine Culture" and "Antimicrobial sensitivity"). - The report includes a range of numeric, semi-quantitative and qualitative results.
- In this example, the specimen (urine) was collected after the request was made. The specimen is linked to the request within the
Bundle
usingSpecimen.request
. - A clinical interpretation/summary of the test results is carried in
DiagnosticReport.conclusion
.
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>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</requester>
</performer>
</ServiceRequest>
</resource>
</entry>
<DiagnosticReport>
</meta>
</identifier>
</basedOn>
</coding>
</category>
</coding>
</code>
</subject>
</performer>
</specimen>
<!-- Urine microscopy, culture and sensitivities group -->
</result>
</DiagnosticReport>
</resource>
</entry>
<Observation>
<!-- Urine microscopy, culture and sensitivities group -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</performer>
<!-- Microscopy group -->
</hasMember>
<!-- Staphylococcus aureus - culture and sensitivities group -->
</hasMember>
</Observation>
</resource>
</entry>
<Observation>
<!-- Microscopy group -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</performer>
<!-- Casts in urine -->
</hasMember>
<!-- White blood cell count in urine -->
</hasMember>
<!-- Red blood cell count in urine -->
</hasMember>
<!-- Epithelial cells in urine -->
</hasMember>
</Observation>
</resource>
</entry>
<Observation>
<!-- Casts in urine -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</coding>
</valueCodeableConcept>
</specimen>
</Observation>
</resource>
</entry>
<Observation>
<!-- White blood cell count in urine -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</valueQuantity>
</specimen>
</Observation>
</resource>
</entry>
<Observation>
<!-- Red blood cell count in urine -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</low>
</high>
</valueRange>
</specimen>
</Observation>
</resource>
</entry>
<Observation>
<!-- Epithelial cells in urine -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</coding>
</valueCodeableConcept>
</specimen>
</Observation>
</resource>
</entry>
<Observation>
<!-- Staphylococcus aureus - culture and sensitivities group -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</performer>
<!-- Staphylococcus aureus - culture result -->
</hasMember>
<!-- Staphylococcus aureus - sensitivities group -->
</hasMember>
</Observation>
</resource>
</entry>
<Observation>
<!-- Staphylococcus aureus - culture result -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</coding>
</valueCodeableConcept>
</specimen>
</Observation>
</resource>
</entry>
<Observation>
<!-- Staphylococcus aureus - sensitivities group -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM procedure reference set -->
</coding>
</code>
</subject>
</performer>
<!-- Staphylococcus aureus - sensitivity result - flucloxacillin -->
</hasMember>
<!-- Staphylococcus aureus - sensitivity result - trimethoprim -->
</hasMember>
<!-- Staphylococcus aureus - sensitivity result - nitrofurantoin -->
</hasMember>
</Observation>
</resource>
</entry>
<Observation>
<!-- Staphylococcus aureus - sensitivity result - flucloxacillin -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</coding>
</valueCodeableConcept>
</specimen>
</Observation>
</resource>
</entry>
<Observation>
<!-- Staphylococcus aureus - sensitivity result - trimethoprim -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</coding>
</valueCodeableConcept>
</specimen>
</Observation>
</resource>
</entry>
<Observation>
<!-- Staphylococcus aureus - sensitivity result - nitrofurantoin -->
</meta>
</identifier>
</coding>
</category>
<!-- From PaLM observable entity reference set -->
</coding>
</code>
</subject>
</performer>
</coding>
</valueCodeableConcept>
</specimen>
</Observation>
</resource>
</entry>
<Specimen>
</meta>
</identifier>
</accessionIdentifier>
</coding>
</type>
</subject>
</request>
</collection>
</Specimen>
</resource>
</entry>
</Bundle>
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"7-8 WELLINGTON PLACE"
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{
"SOUTHGATE"
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]
}
Bundle |
id : Pathology-Bundle-Urine-MCS-01-Report-Example |
meta |
lastUpdated : 2022-02-25T13:47:00+00:00 |
profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle |
identifier |
system : https://tools.ietf.org/html/rfc4122 |
value : 86834956-dc57-4b90-8f1b-6174a887ca27 |
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 : 9727710859 |
name |
use : official |
family : MOXEY |
given : Judy |
gender : female |
birthDate : 2004-05-06 |
address |
line : 1 CASTLEGATE |
city : PICKERING |
district : NORTH YORKSHIRE |
postalCode : YO18 7AY |
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-20220221-000018 |
status : active |
intent : order |
code |
coding |
system : http://snomed.info/sct |
code : 401324008 |
display : Urinary microscopy, culture and sensitivities |
subject |
reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
display : MOXEY, Judy |
authoredOn : 2022-02-21T10:29:00+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-20220225-006301 |
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 : MOXEY, Judy |
issued : 2022-02-25T13:47:00+00:00 |
performer |
reference : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
display : TD008362 PATH LAB 001 |
specimen |
reference : urn:uuid:bde5b0a5-4fb3-4655-acf0-215b93aee006 |
result |
reference : urn:uuid:724714a1-c3a3-48c0-87a3-8d3f6740d24c |
conclusion : Likely to be clinically significant. |
entry |
fullUrl : urn:uuid:724714a1-c3a3-48c0-87a3-8d3f6740d24c |
resource |
id : 724714a1-c3a3-48c0-87a3-8d3f6740d24c |
meta |
profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab |
identifier |
system : https://tools.ietf.org/html/rfc4122 |
value : 7ba81e08-8099-4fdb-9b50-a3c11afb6c0b |
status : final |
category |
coding |
system : http://terminology.hl7.org/CodeSystem/observation-category |
code : laboratory |
display : Laboratory |
code |
coding |
system : http://snomed.info/sct |
code : 401324008 |
display : Urinary microscopy, culture and sensitivities |
subject |
reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
display : MOXEY, Judy |
issued : 2022-02-25T13:47:00+00:00 |
performer |
reference : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
display : TD008362 PATH LAB 001 |
hasMember |
reference : urn:uuid:bd867909-49ca-4a4b-b02f-162790b6800f |
hasMember |
reference : urn:uuid:70af0ca7-a77a-4daa-8aa2-1740433b1c3e |
entry |
fullUrl : urn:uuid:bd867909-49ca-4a4b-b02f-162790b6800f |
resource |
id : bd867909-49ca-4a4b-b02f-162790b6800f |
meta |
profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab |
identifier |
system : https://tools.ietf.org/html/rfc4122 |
value : 02875aea-9815-4d1d-b34e-f9f29b859d02 |
status : final |
category |
coding |
system : http://terminology.hl7.org/CodeSystem/observation-category |
code : laboratory |
display : Laboratory |
code |
coding |
system : http://snomed.info/sct |
code : 127800008 |
display : Microscopic urinalysis |
subject |
reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
display : MOXEY, Judy |
issued : 2022-02-25T13:47:00+00:00 |
performer |
reference : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
display : TD008362 PATH LAB 001 |
hasMember |
reference : urn:uuid:17ec651c-1b6f-43e9-9033-cbb49dbac3db |
hasMember |
reference : urn:uuid:3dc8d5d8-90ef-485c-ad67-d2e3c83ed83f |
hasMember |
reference : urn:uuid:fce26593-20ee-45b6-b805-7eb7d0f0a3fa |
hasMember |
reference : urn:uuid:a4b0fa1f-8679-45bb-82a2-85e4e1bd519a |
entry |
fullUrl : urn:uuid:17ec651c-1b6f-43e9-9033-cbb49dbac3db |
resource |
id : 17ec651c-1b6f-43e9-9033-cbb49dbac3db |
meta |
profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab |
identifier |
system : https://tools.ietf.org/html/rfc4122 |
value : eab75d90-ce08-40a4-8247-34aad0d58873 |
status : final |
category |
coding |
system : http://terminology.hl7.org/CodeSystem/observation-category |
code : laboratory |
display : Laboratory |
code |
coding |
system : http://snomed.info/sct |
code : 51761000237101 |
display : Hyaline casts in mid-stream urine microscopy qualitative result |
subject |
reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
display : MOXEY, Judy |
issued : 2022-02-25T13:47:00+00:00 |
performer |
reference : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
display : TD008362 PATH LAB 001 |
value |
coding |
system : http://snomed.info/sct |
code : 47492008 |
display : Not seen |
specimen |
reference : urn:uuid:bde5b0a5-4fb3-4655-acf0-215b93aee006 |
entry |
fullUrl : urn:uuid:3dc8d5d8-90ef-485c-ad67-d2e3c83ed83f |
resource |
id : 3dc8d5d8-90ef-485c-ad67-d2e3c83ed83f |
meta |
profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab |
identifier |
system : https://tools.ietf.org/html/rfc4122 |
value : e644abd4-2587-486b-b6fe-ea3be866df29 |
status : final |
category |
coding |
system : http://terminology.hl7.org/CodeSystem/observation-category |
code : laboratory |
display : Laboratory |
code |
coding |
system : http://snomed.info/sct |
code : 42331000237103 |
display : White blood cell count in urine |
subject |
reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
display : MOXEY, Judy |
issued : 2022-02-25T13:47:00+00:00 |
performer |
reference : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
display : TD008362 PATH LAB 001 |
value |
value : 35 |
comparator : > |
unit : x10*6/L |
system : http://unitsofmeasure.org |
code : 10^6/L |
specimen |
reference : urn:uuid:bde5b0a5-4fb3-4655-acf0-215b93aee006 |
entry |
fullUrl : urn:uuid:fce26593-20ee-45b6-b805-7eb7d0f0a3fa |
resource |
id : fce26593-20ee-45b6-b805-7eb7d0f0a3fa |
meta |
profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation-Lab |
identifier |
system : https://tools.ietf.org/html/rfc4122 |
value : fc9d8f93-5cc7-43e8-8816-f4f438221b9f |
status : final |
category |
coding |
system : http://terminology.hl7.org/CodeSystem/observation-category |
code : laboratory |
display : Laboratory |
code |
coding |
system : http://snomed.info/sct |
code : 43331000237105 |
display : Red blood cell count in urine |
subject |
reference : urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
display : MOXEY, Judy |
issued : 2022-02-25T13:47:00+00:00 |
performer |
reference : urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
display : TD008362 PATH LAB 001 |
value |
low |
value : 10 |
unit : x10*6/L |
system : http://unitsofmeasure.org |
code : 10^6/L |
high |
value : 35 |
unit : x10*6/L |
system : http://unitsofmeasure.org |
code : 10^6/L |
specimen |
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Bundle.entry[18].resource[0].category[0].coding[0].display[0] | Laboratory |
Bundle.entry[18].resource[0].code[0].coding[0].system[0] | http://snomed.info/sct |
Bundle.entry[18].resource[0].code[0].coding[0].code[0] | 53851000237109 |
Bundle.entry[18].resource[0].code[0].coding[0].display[0] | Organism susceptibility to nitrofurantoin |
Bundle.entry[18].resource[0].subject[0].reference[0] | urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
Bundle.entry[18].resource[0].subject[0].display[0] | MOXEY, Judy |
Bundle.entry[18].resource[0].issued[0] | 2022-02-25T13:47:00+00:00 |
Bundle.entry[18].resource[0].performer[0].reference[0] | urn:uuid:8a6d85b8-9837-4fed-a257-4cf207988338 |
Bundle.entry[18].resource[0].performer[0].display[0] | TD008362 PATH LAB 001 |
Bundle.entry[18].resource[0].value[0].coding[0].system[0] | http://snomed.info/sct |
Bundle.entry[18].resource[0].value[0].coding[0].code[0] | 30714006 |
Bundle.entry[18].resource[0].value[0].coding[0].display[0] | Resistant |
Bundle.entry[18].resource[0].specimen[0].reference[0] | urn:uuid:bde5b0a5-4fb3-4655-acf0-215b93aee006 |
Bundle.entry[19].fullUrl[0] | urn:uuid:bde5b0a5-4fb3-4655-acf0-215b93aee006 |
Bundle.entry[19].resource[0].id[0] | bde5b0a5-4fb3-4655-acf0-215b93aee006 |
Bundle.entry[19].resource[0].meta[0].profile[0] | https://fhir.hl7.org.uk/StructureDefinition/UKCore-Specimen |
Bundle.entry[19].resource[0].identifier[0].system[0] | http://B82033-pickeringmedicalpractice.com/specimen |
Bundle.entry[19].resource[0].identifier[0].value[0] | SPC-REQ-20220221-000024 |
Bundle.entry[19].resource[0].accessionIdentifier[0].system[0] | http://Y8J7D-pathlab001.com/specimen |
Bundle.entry[19].resource[0].accessionIdentifier[0].value[0] | SPC-Lab-20220221-004306 |
Bundle.entry[19].resource[0].status[0] | available |
Bundle.entry[19].resource[0].type[0].coding[0].system[0] | http://snomed.info/sct |
Bundle.entry[19].resource[0].type[0].coding[0].code[0] | 122575003 |
Bundle.entry[19].resource[0].type[0].coding[0].display[0] | Urine specimen |
Bundle.entry[19].resource[0].subject[0].reference[0] | urn:uuid:ab87a3f8-1d37-44a9-804e-5e962598a6e4 |
Bundle.entry[19].resource[0].subject[0].display[0] | MOXEY, Judy |
Bundle.entry[19].resource[0].receivedTime[0] | 2022-02-21T14:58:00+00:00 |
Bundle.entry[19].resource[0].request[0].reference[0] | urn:uuid:1c38d507-9ad7-4b49-ba91-7da204842cac |
Bundle.entry[19].resource[0].collection[0].collected[0] | 2022-02-21T11:07:00+00:00 |