Pathology FHIR Implementation Guide

Notice: This guidance is under active development by NHS England and content may be added or updated on a regular basis.

DiagnosticReport-eu-lab

Summary

A test report, containing the overall findings and clinical interpretation relating to one or more pathology tests.

The report may reference individual test results, test groups or a combination of these. Test results and test groups are represented using the Observation resource and referenced from DiagnosticReport using DiagnosticReport.result.

For information on how test results and test groups are represented, refer to England-Observation-Lab-Pathology (Test Result) and England-Observation-Lab-Pathology (Test Group).

Resource and Profile Links

R4 Resource (Base): DiagnosticReport
Profile: DiagnosticReport-eu-lab

Profile Views

Refer to Profile Descriptions for a definition of the different profile view formats.

DiagnosticReportLabEu (DiagnosticReport)

DiagnosticReport

Element id

DiagnosticReport

Short description

Laboratory Report DiagnosticReport

Alternate names

Report, Test, Result, Results, Labs, Laboratory

Definition

Laboratory Report DiagnosticReport

Comments

This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

Data type

DiagnosticReport

Constraints

dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty()
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management
text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty()

Mappings

rim: Entity. Role, or Act
workflow: Event
v2: ORU -> OBR
rim: Observation[classCode=OBS, moodCode=EVN]

0..1

string

There are no (further) constraints on this element

Element id

DiagnosticReport.id

Short description

Logical id of this artifact

Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Data type

string

Meta

There are no (further) constraints on this element

Element id

DiagnosticReport.meta

Short description

Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Data type

Meta

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

implicitRules

Σ ?!

0..1

uri

There are no (further) constraints on this element

Element id

DiagnosticReport.implicitRules

Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Data type

uri

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

language

0..1

codeBinding

There are no (further) constraints on this element

Element id

DiagnosticReport.language

Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Data type

code

Binding

A human language.

CommonLanguages (preferred)

Binding extensions

maxValueSet	AllLanguages

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

text

0..1

Narrative

There are no (further) constraints on this element

Element id

DiagnosticReport.text

Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Data type

Narrative

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A
rim: Act.text?

contained

0..*

Resource

There are no (further) constraints on this element

Element id

DiagnosticReport.contained

Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Data type

Resource

Mappings

rim: Entity. Role, or Act
rim: N/A

extension

0..*

Extension

Element id

DiagnosticReport.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

DiagnosticReportCompositionR5

0..1

Extension(Reference(Composition))

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5

Short description

Associated Lab Report Composition

Alternate names

extensions, user content

Definition

This extension implements the R5 composition element. It allow to link this DiagnosticReport with the Composition documenting this Laboratory Report.

Comments

Data type

Extension(Reference(Composition))

Extension URL

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

0..1

string

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings

rim: n/a

extension

0..0

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

url

1..1

uriFixed Value

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.url

Short description

identifies the meaning of the extension

Definition

Source of the definition for the extension code - a logical name or a URL.

Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Data type

uri

Fixed value

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition

Mappings

rim: N/A

value[x]

1..1

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.value[x]

Short description

Reference to a Composition resource for the DiagnosticReport structure

Definition

The Composition provides structure to the content of the DiagnosticReport (and only contains contents referenced in the DiagnosticReport) - e.g., to order the sections of an anatomic pathology structured report.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

valueReference

Reference(CompositionLabReportEu)

Data type

Reference(CompositionLabReportEu)

modifierExtension

?! C

0..*

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

identifier

0..*

Identifier

Element id

DiagnosticReport.identifier

Short description

Report identifier

Alternate names

ReportID, Filler ID, Placer ID

Definition

Identifiers assigned to this Laboratory Report by the performer or other systems. It shall be common to several report versions

Requirements

Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

Comments

Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
workflow: Event.identifier
w5: FiveWs.identifier
v2: OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4
rim: id

basedOn

0..*

Reference(ServiceRequestLabEu)

Element id

DiagnosticReport.basedOn

Short description

What was requested

Alternate names

Request

Definition

Details concerning a service requested.

Requirements

This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

Comments

Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

Data type

Reference(ServiceRequestLabEu)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.basedOn
v2: ORC? OBR-2/3?
rim: outboundRelationship[typeCode=FLFS].target

status

Σ ?!

1..1

codeBinding

Element id

DiagnosticReport.status

Short description

Status of the Report

Definition

The status of the diagnostic report.

Requirements

Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

Comments

DiagnosticReport.status and Composition.status shall be aligned, based on the http://hl7.eu/fhir/laboratory/ConceptMap/ConceptMap-eu-diagRptStatus2CompStatus mapping

Data type

code

Binding

The status of the diagnostic report.

DiagnosticReportStatus (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Event.status
w5: FiveWs.status
v2: OBR-25 (not 1:1 mapping)
rim: statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"

category

0..*

CodeableConceptIPS

Element id

DiagnosticReport.category

Short description

Report Category

Alternate names

Department, Sub-department, Service, Discipline

Definition

A code that classifies this laboratory report. Two basic categories has been selected in this guide: laboratory specialty and Study type. Laboratory specialty is characteristic of the laboratory that produced the test result while Study type is an arbitrary classificion of the test type.

Comments

DiagnosticReport.category and Composition.category shall be aligned

Data type

CodeableConceptIPS

Slicing

Unordered, Open, by $this(Pattern)

Binding

Codes for diagnostic service sections.

DiagnosticServiceSectionCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
w5: FiveWs.class
v2: OBR-24
rim: inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code

studyType

0..*

CodeableConceptBinding

Element id

DiagnosticReport.category:studyType

Short description

The way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)

Alternate names

Department, Sub-department, Service, Discipline

Definition

Laboratory services, i.e., results of tests performed, could be characterized using typology of services, commonly called study types. Study type could be seen as an attribute or grouping mechanism that assigns a common clinical sense to certain types of laboratory test results., e.g., Hemoglobin, Platelet count, etc. belongs to 'Hematology study'.

Comments

In comparison to the laboratory specialty which is an attribute of laboratory, study type is a categorization of laboratory service. It needs to be mentioned that classification of test to study types in not standardized.

Data type

CodeableConcept

Binding

Codes for diagnostic service sections.

LabStudyTypesEuVs (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
w5: FiveWs.class
v2: OBR-24
rim: inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code

specialty

0..*

CodeableConceptBinding

Element id

DiagnosticReport.category:specialty

Short description

The clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)

Alternate names

Department, Sub-department, Service, Discipline

Definition

Laboratory specialty is an attribute of any laboratory setting representing professional qualification of the laboratory to execute certain kind of laboratory tests.

Comments

Specialty could be used as parameter for searching/querying of laboratory test results.

Data type

CodeableConcept

Binding

Codes for diagnostic service sections.

LabSpecialtyEuVs (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
w5: FiveWs.class
v2: OBR-24
rim: inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code

code

1..1

CodeableConceptIPSBinding

Element id

DiagnosticReport.code

Short description

Type of (Laboratory) Report

Alternate names

Type

Definition

Specifies that it refers to a Laboratory Report

Comments

At least one DiagnosticReport.code.coding and Composition.type.coding SHALL be equal

Data type

CodeableConceptIPS

Binding

Codes that describe Diagnostic Reports.

LabReportTypesEuVs (preferred)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.code
w5: FiveWs.what[x]
v2: OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)
rim: code

subject

Σ C

1..1

Reference(PatientEuCore | PatientAnimalEu | Device | Group | Location)

Element id

DiagnosticReport.subject

Short description

Who and/or what this report is about

Alternate names

Patient

Definition

Who or what this report is about. The report can be about a human patient, a living subject, a device (e.g. a machine), a location or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).

Requirements

SHALL know the subject context.

Comments

DiagnosticReport and Composition SHALL have the same subject

Data type

Reference(PatientEuCore | PatientAnimalEu | Device | Group | Location)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.subject
w5: FiveWs.subject[x]
v2: PID-3 (no HL7 v2 mapping for Group or Device)
rim: participation[typeCode=SBJ]
w5: FiveWs.subject

encounter

Σ C

0..1

Reference(Encounter)

Element id

DiagnosticReport.encounter

Short description

The healthcare event which this Laboratory Report is about (when test ordered).

Alternate names

Context

Definition

The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.

Requirements

Links the request to the Encounter context.

Comments

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

DiagnosticReport and Composition SHALL have the same encounter.

Data type

Reference(Encounter)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.encounter
w5: FiveWs.context
v2: PV1-19
rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]

effective[x]

0..1

Element id

DiagnosticReport.effective[x]

Short description

Clinically relevant time/time-period for report.

Alternate names

Observation time, Effective Time, Occurrence

Definition

The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

Requirements

Need to know where in the patient history to file/present this report.

Comments

If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Event.occurrence[x]
w5: FiveWs.done[x]
v2: OBR-7
rim: effectiveTime

effectiveDateTime

dateTime

There are no (further) constraints on this element

Data type

dateTime

effectivePeriod

Period

There are no (further) constraints on this element

Data type

Period

issued

0..1

instant

There are no (further) constraints on this element

Element id

DiagnosticReport.issued

Short description

DateTime this version was made

Alternate names

Date published, Date Issued, Date Verified

Definition

The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

Requirements

Clinicians need to be able to check the date that the report was released.

Comments

May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

Data type

instant

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
w5: FiveWs.recorded
v2: OBR-22
rim: participation[typeCode=VRF or AUT].time

performer

Σ C

0..*

Reference(CareTeam | Organization | Practitioner | PractitionerRole)

Element id

DiagnosticReport.performer

Short description

Responsible Diagnostic Service.

Alternate names

Laboratory, Service, Practitioner, Department, Company, Authorized by, Director

Definition

The diagnostic service that is responsible for issuing the report.

Requirements

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

Comments

If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.

Data type

Reference(CareTeam | Organization | Practitioner | PractitionerRole)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.performer.actor
w5: FiveWs.actor
v2: PRT-8 (where this PRT-4-Participation = "PO")
rim: .participation[typeCode=PRF]

resultsInterpreter

Σ C

0..*

Reference(CareTeam | Organization | Practitioner | PractitionerRole)

Element id

DiagnosticReport.resultsInterpreter

Short description

Primary result interpreter

Alternate names

Analyzed by, Reported by

Definition

The practitioner or organization that is responsible for the report's conclusions and interpretations.

Requirements

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

Comments

If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.

Data type

Reference(CareTeam | Organization | Practitioner | PractitionerRole)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.performer.actor
w5: FiveWs.actor
v2: OBR-32, PRT-8 (where this PRT-4-Participation = "PI")
rim: .participation[typeCode=PRF]

specimen

0..*

Reference(SpecimenEu)

Element id

DiagnosticReport.specimen

Short description

Specimens this report is based on.

Definition

Details about the specimens on which this diagnostic report is based.

Requirements

Need to be able to report information about the collected specimens on which the report is based.

Comments

If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

Data type

Reference(SpecimenEu)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: SPM
rim: participation[typeCode=SBJ]

result

0..*

Reference(ObservationResultsLaboratoryEu)

Element id

DiagnosticReport.result

Short description

results

Alternate names

Data, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer

Definition

Observations that are part of this diagnostic report.

Requirements

Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

Comments

Observations can contain observations.

Data type

Reference(ObservationResultsLaboratoryEu)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: OBXs
rim: outboundRelationship[typeCode=COMP].target

imagingStudy

0..0

Reference(ImagingStudy)

There are no (further) constraints on this element

Element id

DiagnosticReport.imagingStudy

Short description

Reference to full details of imaging associated with the diagnostic report

Definition

One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.

Comments

ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

Data type

Reference(ImagingStudy)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]

media

0..*

BackboneElement

Element id

DiagnosticReport.media

Short description

Additional data (like images, diagrams or documents) associated with this report

Alternate names

DICOM, Slides, Scans, DICOM; Slides; Scans; Pictures; Documents; Diagrams

Definition

A list of additional data, other then presented form of the report, associated with this report. This data is generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

Requirements

Some diagnostic reports may include additional data such as images, diagrams or documents that are relevant to the report. This additional information can provide further context and support for the findings presented in the report.

Data type

BackboneElement

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: OBX?
rim: outboundRelationship[typeCode=COMP].target

0..1

string

There are no (further) constraints on this element

Element id

DiagnosticReport.media.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings

rim: n/a

extension

0..*

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.media.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.media.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

comment

0..1

string

Element id

DiagnosticReport.media.comment

Short description

Comment about the image or data (e.g. explanation)

Definition

Allows for a comment about the image or data, such as an explanation of its significance or context within the diagnostic report.

Requirements

The provider of the report should make a comment about each image or data included in the report. This comment can provide valuable context and help the reader understand the significance of the image or data in relation to the overall findings of the report.

Comments

The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value

link

Σ C

1..1

Reference(Media)

Element id

DiagnosticReport.media.link

Short description

Reference to the image or data

Definition

A reference to the image or data associated with this report.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Media)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .value.reference

conclusion

0..1

string

There are no (further) constraints on this element

Element id

DiagnosticReport.conclusion

Short description

Clinical conclusion (interpretation) of test results

Alternate names

Report

Definition

Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.

Requirements

Need to be able to provide a conclusion that is not lost among the basic result data.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: OBX
rim: inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)

conclusionCode

0..*

CodeableConcept

There are no (further) constraints on this element

Element id

DiagnosticReport.conclusionCode

Short description

Codes for the clinical conclusion of test results

Definition

One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

CodeableConcept

Binding

Diagnosis codes provided as adjuncts to the report.

SNOMEDCTClinicalFindings (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: OBX
rim: inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)

presentedForm

0..*

Attachment

Element id

DiagnosticReport.presentedForm

Short description

Entire report as issued (pdf recommended)

Definition

Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

Requirements

Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

Comments

"application/pdf" is recommended as the most reliable and interoperable in this context.

Data type

Attachment

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
att-1: If the Attachment has data, it SHALL have a contentType
data.empty() or contentType.exists()

Mappings

rim: n/a
v2: ED/RP
rim: ED
v2: OBX
rim: text (type=ED)

DiagnosticReportLabEu (DiagnosticReport)

DiagnosticReport

Element id

DiagnosticReport

Short description

Laboratory Report DiagnosticReport

Alternate names

Report, Test, Result, Results, Labs, Laboratory

Definition

Laboratory Report DiagnosticReport

Comments

Data type

DiagnosticReport

Constraints

dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty()
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management
text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty()

Mappings

rim: Entity. Role, or Act
workflow: Event
v2: ORU -> OBR
rim: Observation[classCode=OBS, moodCode=EVN]

0..1

string

There are no (further) constraints on this element

Element id

DiagnosticReport.id

Short description

Logical id of this artifact

Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Data type

string

Meta

There are no (further) constraints on this element

Element id

DiagnosticReport.meta

Short description

Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Data type

Meta

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

implicitRules

Σ ?!

0..1

uri

There are no (further) constraints on this element

Element id

DiagnosticReport.implicitRules

Short description

A set of rules under which this content was created

Definition

Comments

Data type

uri

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

language

0..1

codeBinding

There are no (further) constraints on this element

Element id

DiagnosticReport.language

Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Data type

code

Binding

A human language.

CommonLanguages (preferred)

Binding extensions

maxValueSet	AllLanguages

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

text

0..1

Narrative

There are no (further) constraints on this element

Element id

DiagnosticReport.text

Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

Comments

Data type

Narrative

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A
rim: Act.text?

contained

0..*

Resource

There are no (further) constraints on this element

Element id

DiagnosticReport.contained

Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

Comments

Data type

Resource

Mappings

rim: Entity. Role, or Act
rim: N/A

extension

0..*

Extension

Element id

DiagnosticReport.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

DiagnosticReportCompositionR5

0..1

Extension(Reference(Composition))

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5

Short description

Associated Lab Report Composition

Alternate names

extensions, user content

Definition

This extension implements the R5 composition element. It allow to link this DiagnosticReport with the Composition documenting this Laboratory Report.

Comments

Data type

Extension(Reference(Composition))

Extension URL

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

0..1

string

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings

rim: n/a

extension

0..0

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

url

1..1

uriFixed Value

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.url

Short description

identifies the meaning of the extension

Definition

Source of the definition for the extension code - a logical name or a URL.

Comments

Data type

uri

Fixed value

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition

Mappings

rim: N/A

value[x]

1..1

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.value[x]

Short description

Reference to a Composition resource for the DiagnosticReport structure

Definition

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

valueReference

Reference(CompositionLabReportEu)

Data type

Reference(CompositionLabReportEu)

modifierExtension

?! C

0..*

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

identifier

0..*

Identifier

Element id

DiagnosticReport.identifier

Short description

Report identifier

Alternate names

ReportID, Filler ID, Placer ID

Definition

Identifiers assigned to this Laboratory Report by the performer or other systems. It shall be common to several report versions

Requirements

Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

Comments

Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
workflow: Event.identifier
w5: FiveWs.identifier
v2: OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4
rim: id

basedOn

0..*

Reference(ServiceRequestLabEu)

Element id

DiagnosticReport.basedOn

Short description

What was requested

Alternate names

Request

Definition

Details concerning a service requested.

Requirements

This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

Comments

Data type

Reference(ServiceRequestLabEu)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.basedOn
v2: ORC? OBR-2/3?
rim: outboundRelationship[typeCode=FLFS].target

status

Σ ?!

1..1

codeBinding

Element id

DiagnosticReport.status

Short description

Status of the Report

Definition

The status of the diagnostic report.

Requirements

Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

Comments

DiagnosticReport.status and Composition.status shall be aligned, based on the http://hl7.eu/fhir/laboratory/ConceptMap/ConceptMap-eu-diagRptStatus2CompStatus mapping

Data type

code

Binding

The status of the diagnostic report.

DiagnosticReportStatus (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Event.status
w5: FiveWs.status
v2: OBR-25 (not 1:1 mapping)
rim: statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"

Meta

There are no (further) constraints on this element

Element id

DiagnosticReport.meta

Short description

Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Data type

Meta

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

implicitRules

Σ ?!

0..1

uri

There are no (further) constraints on this element

Element id

DiagnosticReport.implicitRules

Short description

A set of rules under which this content was created

Definition

Comments

Data type

uri

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

language

0..1

codeBinding

There are no (further) constraints on this element

Element id

DiagnosticReport.language

Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Data type

code

Binding

A human language.

CommonLanguages (preferred)

Binding extensions

maxValueSet	AllLanguages

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

text

0..1

Narrative

There are no (further) constraints on this element

Element id

DiagnosticReport.text

Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

Comments

Data type

Narrative

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A
rim: Act.text?

contained

0..*

Resource

There are no (further) constraints on this element

Element id

DiagnosticReport.contained

Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

Comments

Data type

Resource

Mappings

rim: Entity. Role, or Act
rim: N/A

extension

0..*

Extension

Element id

DiagnosticReport.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

DiagnosticReportCompositionR5

0..1

Extension(Reference(Composition))

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5

Short description

Associated Lab Report Composition

Alternate names

extensions, user content

Definition

This extension implements the R5 composition element. It allow to link this DiagnosticReport with the Composition documenting this Laboratory Report.

Comments

Data type

Extension(Reference(Composition))

Extension URL

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

0..1

string

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings

rim: n/a

extension

0..0

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

url

1..1

uriFixed Value

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.url

Short description

identifies the meaning of the extension

Definition

Source of the definition for the extension code - a logical name or a URL.

Comments

Data type

uri

Fixed value

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition

Mappings

rim: N/A

value[x]

1..1

There are no (further) constraints on this element

Element id

DiagnosticReport.extension:DiagnosticReportCompositionR5.value[x]

Short description

Reference to a Composition resource for the DiagnosticReport structure

Definition

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

valueReference

Reference(CompositionLabReportEu)

Data type

Reference(CompositionLabReportEu)

modifierExtension

?! C

0..*

Extension

There are no (further) constraints on this element

Element id

DiagnosticReport.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

identifier

0..*

Identifier

Element id

DiagnosticReport.identifier

Short description

Report identifier

Alternate names

ReportID, Filler ID, Placer ID

Definition

Identifiers assigned to this Laboratory Report by the performer or other systems. It shall be common to several report versions

Requirements

Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

Comments

Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
workflow: Event.identifier
w5: FiveWs.identifier
v2: OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4
rim: id

basedOn

0..*

Reference(ServiceRequestLabEu)

Element id

DiagnosticReport.basedOn

Short description

What was requested

Alternate names

Request

Definition

Details concerning a service requested.

Requirements

This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

Comments

Data type

Reference(ServiceRequestLabEu)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.basedOn
v2: ORC? OBR-2/3?
rim: outboundRelationship[typeCode=FLFS].target

status

Σ ?!

1..1

codeBinding

Element id

DiagnosticReport.status

Short description

Status of the Report

Definition

The status of the diagnostic report.

Requirements

Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

Comments

DiagnosticReport.status and Composition.status shall be aligned, based on the http://hl7.eu/fhir/laboratory/ConceptMap/ConceptMap-eu-diagRptStatus2CompStatus mapping

Data type

code

Binding

The status of the diagnostic report.

DiagnosticReportStatus (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Event.status
w5: FiveWs.status
v2: OBR-25 (not 1:1 mapping)
rim: statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"

Additional Guidance

meta.profile

This element SHALL be populated with a value of http://hl7.eu/fhir/laboratory/StructureDefinition/DiagnosticReport-eu-lab

extension:noteR5

General comments about the test report. Refer to Extension UKCore-DiagnosticReportNote for further information.

Information relating specifically to the report conclusion SHOULD be conveyed using DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode.

Notes may be captured at a number of levels within a test report. There may also be notes related to the specimen, test group or individual test results. It is the consuming systems responsibility to ensure all relevant notes are displayed to the user.

identifier

This element SHOULD be populated with at least one unique, persistent business identifier for the test report, assigned by the performing laboratory.

basedOn

Reference to the ServiceRequest.

status

This element SHALL be populated with a value taken from the DiagnosticReportStatus ValueSet.

category

As a minimum, this element SHOULD be populated with the following value, taken from the LabSpecialtyEuVs ValueSet:

"category": {
    "coding": [
        {
            "system": "http://snomed.info/sct",
            "code": "394915009",
            "display": "General pathology (speciality)"
        }
    ]
}

code

This element SHALL be populated with the following value, taken from the UKCoreReportCode ValueSet.

"code": {
    "coding": [
        {
            "system": "http://snomed.info/sct",
            "code": "721981007",
            "display": "Diagnostic studies report"
        }
    ]
}

Note: The clinical code and name of a test result or a test group are defined in the code element of the corresponding Observation resource.

subject

Reference to the Patient.

issued

The date and time the test report was issued.

performer

Reference to the performing Organization.

specimen

Reference(s) to the Specimen(s) used during testing.

result

References to the results included in the test report.

The references may be to individual test results, test groups or a combination of these. Test results and test groups are represented using the Observation resource. Refer to England-Observation-Lab-Pathology (Test Result) and England-Observation-Lab-Pathology (Test Group) for further information.

Test results which are part of a test group will not be referenced by this element; the reference will be to the test group which will in turn reference the associated test results.

conclusion

A clinical interpretation/summary of the test results in a free text format.

conclusionCode

A coded finding of the test report.