Notice: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
Release Notes
v0.3.1 (11/02/2026)
- Updated Composition-eu-lab as follows:
- Updated the guidance for
Composition.sectionto specify that references to test groupObservations (e.g. a Full Blood Count) only need to be linked at the parent level. References fromComposition.sectionto the individual test resultObservations within a test group are not required. - Updated the accompanying diagram to reflect these changes.
- Updated the guidance for
- Updated the Full Blood Count Report example as follows:
- Removed references from
Composition.sectionto the individual test resultObservations. Retained the reference fromComposition.sectionto the parent test groupObservation. - Updated
ServiceRequest.requesterto referencePractitionerRolerather thanPractitioner.
- Removed references from
- Updated the examples to remove the display elements from
OrganizationandPractitionerreferences e.g. "display": "PICKERING MEDICAL PRACTICE".
v0.3.0 (09/02/2026)
- Changed
Bundle.typefrom "message" to "document". As part of this change, theMessageHeaderresource has been replaced withComposition. - Updated the How to Construct Bundles page (under the Design menu bar item) as follows:
- Updated the list of referenced profiles and the associated diagram in the Test Report Bundles section, replacing
MessageHeaderwithComposition. - Removed the Test Request Bundles section.
- Updated the list of referenced profiles and the associated diagram in the Test Report Bundles section, replacing
- Added CodeSystem England-DeviatingResultIndicator.
- Added ValueSet England-DeviatingResultIndicator.
- Created a ConceptMaps page (under the FHIR Assets menu bar item) and added ConceptMap England-DeviatingResultIndicator.
- Added Composition-eu-lab.
- Updated UKCore-Observation-Lab (Test Group) as follows:
- Updated the guidance to specify that
Observation.codeshall (where possible) be populated using the Pathology Bounded Code List (PBCL) observables simple reference set, rather than the PaLM (Pathology and Laboratory Medicine) procedure simple reference set.
- Updated the guidance to specify that
- Updated UKCore-Observation-Lab (Test Result) as follows:
- Replaced the value set referenced by
Observation.interpretationwith ValueSet England-DeviatingResultIndicator and updated the guidance.
- Replaced the value set referenced by
- Updated UKCore-Patient as follows:
- Added guidance to specify that only
Patient.identifier(NHS Number) shall be populated.
- Added guidance to specify that only
- Updated UKCore-ServiceRequest-Lab as follows:
- Updated the guidance to specify that
ServiceRequest.intentshould be populated with a value oforder. - Added guidance to specify that
ServiceRequest.categoryshould be populated with SNOMED code 108252007 – Laboratory procedure. - Removed the guidance for
ServiceRequest.codeas this data element is not required to be populated. - Added guidance to specify that
ServiceRequest.requestershall always reference aPractitionerRole. This in turn shall reference the requestingOrganizationandPractitioner.
- Updated the guidance to specify that
- Removed the MessageDefinitions page (under the FHIR Assets menu bar item).
- Updated the Design Overview page to reflect the revised FHIR profile guidance outlined above.
- Updated the examples to reflect the revised FHIR profile guidance outlined above, and to incorporate other changes:
- Removed most of the examples apart from C-Reactive Protein Report and Full Blood Count Report. Additional examples will be reintroduced in future releases of the implementation guide.
- Removed the XML versions of the examples, as the associated data exchange architecture currently supports only JSON.
- Changed
Bundle.typeto "document" and replacedMessageHeaderwithComposition. - Removed all patient related data from the examples, except for NHS Number.
- Removed all
Resource.meta.profile references. - Updated the examples to demonstrate use of the
UKCore-PractitionerRoleprofile. - Replaced UCUM-coded units of measure with text-only units and removed the associated
Quantity.codeandQuantity.systemdata elements. - Updated
Specimen.typeto use text values instead of SNOMED CT concepts.
v0.2.0 (02/09/2025)
- Updated to use the
UK-Core-Observation-Labprofile for representing test groups (i.e. batteries, panels and profiles) rather than theUK-Core-Observation-Group-Labprofile. - Added Extension UKCore-ObservationOrganizer. This extension mirrors the
Observation.organizerdata element introduced in FHIR R6, which indicates whether anObservationis being used to represent a test group. Updated the relevant FHIR examples to use the new extension. - Added an open slice to
UK-Core-Observation-Lab.codeto support the use of the following SNOMED CT reference sets:- 1853561000000109 | PaLM (Pathology and Laboratory Medicine) procedure simple reference set
- 1853551000000106 | PaLM (Pathology and Laboratory Medicine) observable entity simple reference set
- 999002881000000100 | Pathology Bounded Code List (PBCL) observables simple reference set
- Created separate FHIR value sets for the SNOMED PaLM and SNOMED PBCL observable entity reference sets (these were previously combined in a single FHIR value set).
- Added guidance for using the standard FHIR Extension valueset-reference with
UK-Core-Observation-Lab.code. - Removed references to the
UKCore-BundleandUKCore-MessageHeaderprofiles and replaced them with theBundleandMessageHeaderresources from the base FHIR specification. - Added guidance to UKCore-Observation-Lab (Test Result) to clarify that units of measure must only be represented as text rather than using a coded representation.
- Updated all links to the UK Core Implementation Guide to the latest version (STU3 Sequence).
- Added the CapabilityStatements and MessageDefinitions pages (both under the FHIR Assets menu bar item).
- Updated the Home page as follows:
- Renamed the 'Pathology Data Products' section heading to 'SNOMED CT for Pathology Reporting' and updated the associated content.
- Added a section for the DAPB4101 Pathology and Laboratory Medicine Reporting Information Standard.
- Removed the Build menu bar item which contained the 'How to Construct a Pathology Test Request Bundle' and 'How to Construct a Pathology Test Report Bundle' pages. The content from these pages has been combined into a How to Construct Bundles page and added to the Design menu bar item.
- Updated the Full Blood Count Report example to include
Observation.interpretationfor out of range values. - Updated the Lipids Profile and HbA1c Report example to include the SNOMED CT PaLM concept for serum cholesterol/high density lipoprotein ratio result.
- Updated the current GP practice data flows diagram and description in the Background page to include message acknowledgements.
- Updated to use the latest NHS England FHIR Implementation Guide template.
v0.1.8 (30/08/2024)
- Updated the following examples:
- Full Blood Count Request - changed the data element used to carry clinical context from
ServiceRequest.notetoServiceRequest.reasonCode.text - Full Blood Count Report - changed the data element used to carry clinical context from
ServiceRequest.notetoServiceRequest.reasonCode.text - DiagnosticReport Snippets - added an example for
extension-DiagnosticReport.note, changedDiagnosticReport.basedOn.typefrom "http://hl7.org/fhir/StructureDefinition/ServiceRequest" to "ServiceRequest" and added an additional instance ofDiagnosticReport.categoryto illustrate how a laboratory department name may be carried. - ServiceRequest Snippets - added examples for
ServiceRequest.identifier.typeto illustrate the use of separate business identifiers for the laboratory service requester and laboratory service provider.
- Full Blood Count Request - changed the data element used to carry clinical context from
- Added additional guidance to the Design Overview page and UKCore-Observation-Lab (Test Result) profile definition regarding the use of text for semi-quantitative and qualitative result types.
- Added an Extensions page (under the FHIR Assets menu bar item).
v0.1.7 (21/06/2024)
- Added two new
Bundleexamples, Glucose Tolerance Test Report Unstructured and Urine MC&S Report Unstructured, based on the existing structured versions of the same examples. The unstructured versions illustrate how complex reports may be represented using formatted text within a singleObservation, rather than using a set of structured, codedObservations. - Updated the Urine MC&S Report Structured example to include a new overarching test group
Observation, with the following code (taken from the SNOMED CT PaLM procedure reference set):- 401324008 | Urinary microscopy, culture and sensitivities
- Added the following new
Bundleexamples:- C-Reactive Protein Request
- C-Reactive Protein Report
- Updated
UKCore-Observation-Lab.codein the examples to use content from the SNOMED CT PBCL reference set alongside equivalent content from the SNOMED CT PaLM content reference set. - Updated
UKCore-Practitioner.identifierin theBundleexamples with a test GMC code for the requesting practitioner.
v0.1.6 (17/05/2024)
- Updated the Additional Guidance section in each of the Profiles to align with the content and format used in the UK Core Implementation Guide (STU2 Sequence).
- Added links from each of the Profiles to the examples in the Examples Index, and also added links to the examples in the UK Core Implementation Guide. Included a new Table view for all examples.
- Added a new Data Mapping page (under the Design menu bar item). This provides a set of data mappings between the FHIR profiles that are referenced by this implementation guide and the PMIP EDIFACT (NHS003) messaging specification.
- Updated the CodeSystems and ValueSets pages (under the FHIR Assets menu bar item).
v0.1.5 (01/03/2024)
- Updated the examples in the Examples Index to correct various validation errors.
- Updated the Design Overview page to include a description of how various types of test result (i.e. quantitative, semi-quantitative, qualitative, quantitative with an interpretation, narrative) should be represented and added corresponding
Observationexamples to the Examples Index. - Included changes to the pathology related profiles that were made as part of the HL7 UK STU2 Ballot process.
v0.1.4 (29/12/2023)
- Removed the content from the Transport and Acknowledgement Framework pages (under the Design menu bar item). Awaiting confirmation of what data exchange and acknowledgement approach will be adopted for FHIR UK Core R4 based interactions between pathology laboratory systems and GP EPR systems.
- Added the following new
Bundleexamples:- Lipids Profile and HbA1c Request
- Lipids Profile and HbA1c Report
- Added an overview of the Implementation Guide Structure to the Home page.
- Updated the Glossary.
v0.1.3 (08/12/2023)
- Added a new Background page (under the Design menu bar item). This incorporates content from the previous version of the Design Overview page, with additional material describing GP practice pathology data flows.
- Updated the Design Overview page (under the Design menu bar item). This now contains additional content, including a summary of the FHIR design approach that has been adopted as part of this implementation guide and the use of SNOMED CT.
- Updated references to the PaLM and PBCL SNOMED CT reference sets throughout the implementation guide.
v0.1.2 (30/10/2023)
- Removed all FHIR STU3 related content, in line with the recent announcement from the NHS England Interoperability Standards Team that CareConnect has been deprecated and all development on the CareConnect FHIR STU3 assets has ceased.
- Updated the examples in the Examples Index to include a populated
categoryelement forUKCore-DiagnosticReport-Lab,UKCore-Observation-Group-LabandUKCore-Observation-Lab. - Updated the structure of the implementation guide to align with the latest NHS England FHIR Implementation Guide template.
v0.1.1 (04/10/2023)
- Updated to incorporate a new set of laboratory specific FHIR R4 derived profiles, as defined in the UK Core Implementation Guide (STU2 Sequence):
UKCore-DiagnosticReport-LabUKCore-Observation-Group-LabUKCore-Observation-LabUKCore-ServiceRequest-Lab- Note:
UKCore-Specimendoes not have a pathology specific derived profile.
- Updated to use the NHS England FHIR Implementation Guide template.
v0.1.0 (17/04/2023)
- Initial draft.