DiagnosticReport

Description

DiagnosticReport is shown in Patient Finder in the report category. The text found in either the conclusion or the presentedForm.data will be shown pseudonymised in the Patient Finder application. For example the text found in the example below will go from: The patient John Doe has a broken bone. to: The patient [FIRSTNAME] [LASTNAME] has a broken bone..

Notes on specific fields:

  • code: The code is a required field in FHIR, but it is not used in Patient Finder.
  • media.link.reference: Since we do not load the resource Media, we will only show the identifier of this media as a textual value, so it can be referenced in the source data if one has acces

Instances

An example of a DiagnosticReport resource can be found here: DiagnosticReport Example 1

Profile

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueS Σ0..1string
periodΣ0..1Period
assignerΣ0..1Reference(Organization)
basedOn0..*Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
statusS Σ ?!1..1codeBinding
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ0..1uri
versionΣ0..1string
codeS Σ0..1code
displayS Σ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
codeΣ1..1CodeableConceptBinding
subjectS Σ0..1Reference(Patient)
encounterΣ0..1Reference(Encounter)
effectiveDateTimeS Σ0..1dateTime
id0..1string
extensionI0..*Extension
startS Σ I0..1dateTime
endΣ I0..1dateTime
issuedΣ0..1instant
performerS Σ0..*Reference(Practitioner | Organization)
resultsInterpreterΣ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam)
specimen0..*Reference(Specimen)
result0..*Reference(Observation)
imagingStudy0..*Reference(ImagingStudy)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
comment0..1string
conclusionS0..1string
conclusionCode0..*CodeableConcept
id0..1string
extensionI0..*Extension
contentTypeΣ0..1codeBinding
languageΣ0..1codeBinding
data0..1base64Binary
urlΣ0..1url
sizeΣ0..1unsignedInt
hashΣ0..1base64Binary
titleΣ0..1string
creationΣ0..1dateTime
<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="pf-diagnostic-report" />
    <url value="https://fhir.iqvia.com/patientfinder/StructureDefinition/pf-diagnostic-report" />
    <name value="PatientFinderDiagnosticReport" />
    <title value="DiagnosticReport" />
    <status value="draft" />
    <description value="DiagnosticReport is represented the Patient Finder category report. The text in the conclusion will be pseudonymized." />
    <fhirVersion value="4.0.1" />
    <mapping>
        <identity value="fhir-patient-finder-mapping" />
        <name value="FHIR to Patient Finder Mapping" />
    </mapping>
    <kind value="resource" />
    <abstract value="false" />
    <type value="DiagnosticReport" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
    <derivation value="constraint" />
    <differential>
        <element id="DiagnosticReport.identifier">
            <path value="DiagnosticReport.identifier" />
            <mustSupport value="true" />
        </element>
        <element id="DiagnosticReport.identifier.value">
            <path value="DiagnosticReport.identifier.value" />
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report source id" />
            </mapping>
        </element>
        <element id="DiagnosticReport.status">
            <path value="DiagnosticReport.status" />
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report status" />
            </mapping>
        </element>
        <element id="DiagnosticReport.category">
            <path value="DiagnosticReport.category" />
            <mustSupport value="true" />
        </element>
        <element id="DiagnosticReport.category.coding.code">
            <path value="DiagnosticReport.category.coding.code" />
            <mustSupport value="true" />
        </element>
        <element id="DiagnosticReport.category.coding.display">
            <path value="DiagnosticReport.category.coding.display" />
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report report type" />
            </mapping>
        </element>
        <element id="DiagnosticReport.subject">
            <path value="DiagnosticReport.subject" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="DiagnosticReport.effective[x]">
            <path value="DiagnosticReport.effective[x]" />
            <slicing>
                <discriminator>
                    <type value="type" />
                    <path value="$this" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="DiagnosticReport.effective[x]:effectiveDateTime">
            <path value="DiagnosticReport.effective[x]" />
            <sliceName value="effectiveDateTime" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="dateTime" />
            </type>
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report date" />
            </mapping>
        </element>
        <element id="DiagnosticReport.effective[x]:effectivePeriod">
            <path value="DiagnosticReport.effective[x]" />
            <sliceName value="effectivePeriod" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Period" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="DiagnosticReport.effective[x]:effectivePeriod.start">
            <path value="DiagnosticReport.effective[x].start" />
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report date" />
            </mapping>
        </element>
        <element id="DiagnosticReport.performer">
            <path value="DiagnosticReport.performer" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
            </type>
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="(Practitioner) report care provider" />
            </mapping>
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="(Organization) report specialism" />
            </mapping>
        </element>
        <element id="DiagnosticReport.media">
            <path value="DiagnosticReport.media" />
            <mustSupport value="true" />
        </element>
        <element id="DiagnosticReport.media.link">
            <path value="DiagnosticReport.media.link" />
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report attachment id" />
            </mapping>
        </element>
        <element id="DiagnosticReport.conclusion">
            <path value="DiagnosticReport.conclusion" />
            <mustSupport value="true" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report content" />
            </mapping>
        </element>
        <element id="DiagnosticReport.presentedForm">
            <path value="DiagnosticReport.presentedForm" />
            <mustSupport value="true" />
        </element>
        <element id="DiagnosticReport.presentedForm.data">
            <path value="DiagnosticReport.presentedForm.data" />
            <mapping>
                <identity value="fhir-patient-finder-mapping" />
                <map value="report content" />
            </mapping>
        </element>
    </differential>
</StructureDefinition>
{
    "resourceType": "StructureDefinition",
    "id": "pf-diagnostic-report",
    "url": "https://fhir.iqvia.com/patientfinder/StructureDefinition/pf-diagnostic-report",
    "name": "PatientFinderDiagnosticReport",
    "title": "DiagnosticReport",
    "status": "draft",
    "description": "DiagnosticReport is represented the Patient Finder category report. The text in the conclusion will be pseudonymized.",
    "fhirVersion": "4.0.1",
    "mapping":  [
        {
            "identity": "fhir-patient-finder-mapping",
            "name": "FHIR to Patient Finder Mapping"
        }
    ],
    "kind": "resource",
    "abstract": false,
    "type": "DiagnosticReport",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "DiagnosticReport.identifier",
                "path": "DiagnosticReport.identifier",
                "mustSupport": true
            },
            {
                "id": "DiagnosticReport.identifier.value",
                "path": "DiagnosticReport.identifier.value",
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report source id"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.status",
                "path": "DiagnosticReport.status",
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report status"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.category",
                "path": "DiagnosticReport.category",
                "mustSupport": true
            },
            {
                "id": "DiagnosticReport.category.coding.code",
                "path": "DiagnosticReport.category.coding.code",
                "mustSupport": true
            },
            {
                "id": "DiagnosticReport.category.coding.display",
                "path": "DiagnosticReport.category.coding.display",
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report report type"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.subject",
                "path": "DiagnosticReport.subject",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Patient"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "DiagnosticReport.effective[x]",
                "path": "DiagnosticReport.effective[x]",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "$this"
                        }
                    ],
                    "ordered": false,
                    "rules": "open"
                }
            },
            {
                "id": "DiagnosticReport.effective[x]:effectiveDateTime",
                "path": "DiagnosticReport.effective[x]",
                "sliceName": "effectiveDateTime",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "dateTime"
                    }
                ],
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report date"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.effective[x]:effectivePeriod",
                "path": "DiagnosticReport.effective[x]",
                "sliceName": "effectivePeriod",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Period"
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "DiagnosticReport.effective[x]:effectivePeriod.start",
                "path": "DiagnosticReport.effective[x].start",
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report date"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.performer",
                "path": "DiagnosticReport.performer",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Practitioner",
                            "http://hl7.org/fhir/StructureDefinition/Organization"
                        ]
                    }
                ],
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "(Practitioner) report care provider"
                    },
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "(Organization) report specialism"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.media",
                "path": "DiagnosticReport.media",
                "mustSupport": true
            },
            {
                "id": "DiagnosticReport.media.link",
                "path": "DiagnosticReport.media.link",
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report attachment id"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.conclusion",
                "path": "DiagnosticReport.conclusion",
                "mustSupport": true,
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report content"
                    }
                ]
            },
            {
                "id": "DiagnosticReport.presentedForm",
                "path": "DiagnosticReport.presentedForm",
                "mustSupport": true
            },
            {
                "id": "DiagnosticReport.presentedForm.data",
                "path": "DiagnosticReport.presentedForm.data",
                "mapping":  [
                    {
                        "identity": "fhir-patient-finder-mapping",
                        "map": "report content"
                    }
                ]
            }
        ]
    }
}
DiagnosticReport
DefinitionThe findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.
Cardinality0...*
AliasReport, Test, Result, Results, Labs, Laboratory
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.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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-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-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • v2: ORU -> OBR
  • rim: Observation[classCode=OBS, moodCode=EVN]
DiagnosticReport.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
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.

DiagnosticReport.meta
DefinitionThe 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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
DiagnosticReport.implicitRules
DefinitionA 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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
DiagnosticReport.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
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).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
DiagnosticReport.text
DefinitionA 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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: Act.text?
DiagnosticReport.contained
DefinitionThese 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.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
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.

Mappings
  • rim: N/A
DiagnosticReport.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

Invariants
  • 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
DiagnosticReport.modifierExtension
DefinitionMay 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).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
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

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.

Invariants
  • 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
DiagnosticReport.identifier
DefinitionIdentifiers assigned to this report by the performer or other systems.
Cardinality0...*
TypeIdentifier
Must SupportTrue
SummaryTrue
AliasReportID, Filler ID, Placer ID
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

Usually assigned by the Information System of the diagnostic service provider (filler id).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • 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
DiagnosticReport.identifier.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.identifier.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
DiagnosticReport.identifier.use
DefinitionThe purpose of this identifier.
Cardinality0...1
Typecode
Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)
ModifierTrue
SummaryTrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: N/A
  • rim: Role.code or implied by context
DiagnosticReport.identifier.type
DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Cardinality0...1
TypeCodeableConcept
Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Identifier Type Codes (extensible)
SummaryTrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: CX.5
  • rim: Role.code or implied by context
DiagnosticReport.identifier.system
DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique.
Cardinality0...1
Typeuri
SummaryTrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

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

http://www.acme.com/identifiers/patient


Mappings
  • v2: CX.4 / EI-2-4
  • rim: II.root or Role.id.root
  • servd: ./IdentifierType
DiagnosticReport.identifier.value
DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system.
Cardinality0...1
Typestring
Must SupportTrue
SummaryTrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

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

123456


Mappings
  • v2: CX.1 / EI.1
  • rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
  • servd: ./Value
  • fhir-patient-finder-mapping: report source id
DiagnosticReport.identifier.period
DefinitionTime period during which identifier is/was valid for use.
Cardinality0...1
TypePeriod
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: CX.7 + CX.8
  • rim: Role.effectiveTime or implied by context
  • servd: ./StartDate and ./EndDate
DiagnosticReport.identifier.assigner
DefinitionOrganization that issued/manages the identifier.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: CX.4 / (CX.4,CX.9,CX.10)
  • rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
  • servd: ./IdentifierIssuingAuthority
DiagnosticReport.basedOn
DefinitionDetails concerning a service requested.
Cardinality0...*
TypeReference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
AliasRequest
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.basedOn
  • v2: ORC? OBR-2/3?
  • rim: outboundRelationship[typeCode=FLFS].target
DiagnosticReport.status
DefinitionThe status of the diagnostic report.
Cardinality1...1
Typecode
Binding

The status of the diagnostic report.

DiagnosticReportStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • 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"
  • fhir-patient-finder-mapping: report status
DiagnosticReport.category
DefinitionA code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
Cardinality0...*
TypeCodeableConcept
Binding

Codes for diagnostic service sections.

DiagnosticServiceSectionCodes (example)
Must SupportTrue
SummaryTrue
AliasDepartment, Sub-department, Service, Discipline
Comments

Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.class
  • v2: OBR-24
  • rim: inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
DiagnosticReport.category.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.category.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
DiagnosticReport.category.coding
DefinitionA reference to a code defined by a terminology system.
Cardinality0...*
TypeCoding
SummaryTrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: C*E.1-8, C*E.10-22
  • rim: union(., ./translation)
  • orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
DiagnosticReport.category.coding.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.category.coding.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
DiagnosticReport.category.coding.system
DefinitionThe identification of the code system that defines the meaning of the symbol in the code.
Cardinality0...1
Typeuri
SummaryTrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: C*E.3
  • rim: ./codeSystem
  • orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
DiagnosticReport.category.coding.version
DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Cardinality0...1
Typestring
SummaryTrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: C*E.7
  • rim: ./codeSystemVersion
  • orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
DiagnosticReport.category.coding.code
DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Cardinality0...1
Typecode
Must SupportTrue
SummaryTrue
Requirements

Need to refer to a particular code in the system.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: C*E.1
  • rim: ./code
  • orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
DiagnosticReport.category.coding.display
DefinitionA representation of the meaning of the code in the system, following the rules of the system.
Cardinality0...1
Typestring
Must SupportTrue
SummaryTrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: C*E.2 - but note this is not well followed
  • rim: CV.displayName
  • orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
  • fhir-patient-finder-mapping: report report type
DiagnosticReport.category.coding.userSelected
DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Cardinality0...1
Typeboolean
SummaryTrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: Sometimes implied by being first
  • rim: CD.codingRationale
  • orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
DiagnosticReport.category.text
DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Cardinality0...1
Typestring
SummaryTrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: C*E.9. But note many systems use C*E.2 for this
  • rim: ./originalText[mediaType/code="text/plain"]/data
  • orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
DiagnosticReport.code
DefinitionA code or name that describes this diagnostic report.
Cardinality1...1
TypeCodeableConcept
Binding

Codes that describe Diagnostic Reports.

LOINCDiagnosticReportCodes (preferred)
SummaryTrue
AliasType
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • 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
DiagnosticReport.subject
DefinitionThe subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.
Cardinality0...1
TypeReference(Patient)
Must SupportTrue
SummaryTrue
AliasPatient
Requirements

SHALL know the subject context.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • 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
DiagnosticReport.encounter
DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
AliasContext
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).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.encounter
  • w5: FiveWs.context
  • v2: PV1-19
  • rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
DiagnosticReport.effective[x]
DefinitionThe 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.
Cardinality0...1
TypedateTime
SummaryTrue
AliasObservation time, Effective Time, Occurrence
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.

SlicingUnordered, Open, by $this(Type)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • v2: OBR-7
  • rim: effectiveTime
DiagnosticReport.effective[x]:effectiveDateTime
DefinitionThe 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.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
AliasObservation time, Effective Time, Occurrence
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • v2: OBR-7
  • rim: effectiveTime
  • fhir-patient-finder-mapping: report date
DiagnosticReport.effective[x]:effectivePeriod
DefinitionThe 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.
Cardinality0...1
TypePeriod
Must SupportTrue
SummaryTrue
AliasObservation time, Effective Time, Occurrence
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • v2: OBR-7
  • rim: effectiveTime
DiagnosticReport.effective[x]:effectivePeriod.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.effective[x]:effectivePeriod.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
DiagnosticReport.effective[x]:effectivePeriod.start
DefinitionThe start of the period. The boundary is inclusive.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
Comments

If the low element is missing, the meaning is that the low boundary is not known.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: DR.1
  • rim: ./low
  • fhir-patient-finder-mapping: report date
DiagnosticReport.effective[x]:effectivePeriod.end
DefinitionThe end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
Cardinality0...1
TypedateTime
SummaryTrue
Comments

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: DR.2
  • rim: ./high
DiagnosticReport.issued
DefinitionThe date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.
Cardinality0...1
Typeinstant
SummaryTrue
AliasDate published, Date Issued, Date 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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.recorded
  • v2: OBR-22
  • rim: participation[typeCode=VRF or AUT].time
DiagnosticReport.performer
DefinitionThe diagnostic service that is responsible for issuing the report.
Cardinality0...*
TypeReference(Practitioner | Organization)
Must SupportTrue
SummaryTrue
AliasLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
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

This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • v2: PRT-8 (where this PRT-4-Participation = "PO")
  • rim: .participation[typeCode=PRF]
  • fhir-patient-finder-mapping: (Practitioner) report care provider
  • fhir-patient-finder-mapping: (Organization) report specialism
DiagnosticReport.resultsInterpreter
DefinitionThe practitioner or organization that is responsible for the report's conclusions and interpretations.
Cardinality0...*
TypeReference(Practitioner | PractitionerRole | Organization | CareTeam)
SummaryTrue
AliasAnalyzed by, Reported by
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

Might not be the same entity that takes responsibility for the clinical report.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • v2: OBR-32, PRT-8 (where this PRT-4-Participation = "PI")
  • rim: .participation[typeCode=PRF]
DiagnosticReport.specimen
DefinitionDetails about the specimens on which this diagnostic report is based.
Cardinality0...*
TypeReference(Specimen)
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: SPM
  • rim: participation[typeCode=SBJ]
DiagnosticReport.result
Definition[Observations](observation.html) that are part of this diagnostic report.
Cardinality0...*
TypeReference(Observation)
AliasData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
Requirements

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

Comments

Observations can contain observations.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: OBXs
  • rim: outboundRelationship[typeCode=COMP].target
DiagnosticReport.imagingStudy
DefinitionOne 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.
Cardinality0...*
TypeReference(ImagingStudy)
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]
DiagnosticReport.media
DefinitionA list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).
Cardinality0...*
TypeBackboneElement
Must SupportTrue
SummaryTrue
AliasDICOM, Slides, Scans
Requirements

Many diagnostic services include images in the report as part of their service.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: OBX?
  • rim: outboundRelationship[typeCode=COMP].target
DiagnosticReport.media.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.media.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

Invariants
  • 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
DiagnosticReport.media.modifierExtension
DefinitionMay 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).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
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

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.

Invariants
  • 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
DiagnosticReport.media.comment
DefinitionA comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.
Cardinality0...1
Typestring
Requirements

The provider of the report should make a comment about each image included in 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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
DiagnosticReport.media.link
DefinitionReference to the image source.
Cardinality1...1
TypeReference(Media)
Must SupportTrue
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .value.reference
  • fhir-patient-finder-mapping: report attachment id
DiagnosticReport.conclusion
DefinitionConcise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.
Cardinality0...1
Typestring
Must SupportTrue
AliasReport
Requirements

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: OBX
  • rim: inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
  • fhir-patient-finder-mapping: report content
DiagnosticReport.conclusionCode
DefinitionOne or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.
Cardinality0...*
TypeCodeableConcept
Binding

Diagnosis codes provided as adjuncts to the report.

SNOMEDCTClinicalFindings (example)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: OBX
  • rim: inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
DiagnosticReport.presentedForm
DefinitionRich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.
Cardinality0...*
TypeAttachment
Must SupportTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: OBX
  • rim: text (type=ED)
DiagnosticReport.presentedForm.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.presentedForm.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
DiagnosticReport.presentedForm.contentType
DefinitionIdentifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.
Cardinality0...1
Typecode
Binding

The mime type of an attachment. Any valid mime type is allowed.

Mime Types (required)
SummaryTrue
Requirements

Processors of the data need to be able to know how to interpret the data.

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

text/plain; charset=UTF-8, image/png


Mappings
  • v2: ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used
  • rim: ./mediaType, ./charset
DiagnosticReport.presentedForm.language
DefinitionThe human language of the content. The value can be any valid value according to BCP 47.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
SummaryTrue
Requirements

Users need to be able to choose between the languages in a set of attachments.

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

en-AU


Mappings
  • rim: ./language
DiagnosticReport.presentedForm.data
DefinitionThe actual data of the attachment - a sequence of bytes, base64 encoded.
Cardinality0...1
Typebase64Binary
Requirements

The data needs to able to be transmitted inline.

Comments

The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • v2: ED.5
  • rim: ./data
  • fhir-patient-finder-mapping: report content
DiagnosticReport.presentedForm.url
DefinitionA location where the data can be accessed.
Cardinality0...1
Typeurl
SummaryTrue
Requirements

The data needs to be transmitted by reference.

Comments

If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

http://www.acme.com/logo-small.png


Mappings
  • v2: RP.1+RP.2 - if they refer to a URL (see v2.6)
  • rim: ./reference/literal
DiagnosticReport.presentedForm.size
DefinitionThe number of bytes of data that make up this attachment (before base64 encoding, if that is done).
Cardinality0...1
TypeunsignedInt
SummaryTrue
Requirements

Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

Comments

The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A (needs data type R3 proposal)
DiagnosticReport.presentedForm.hash
DefinitionThe calculated hash of the data using SHA-1. Represented using base64.
Cardinality0...1
Typebase64Binary
SummaryTrue
Requirements

Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

Comments

The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
DiagnosticReport.presentedForm.title
DefinitionA label or set of text to display in place of the data.
Cardinality0...1
Typestring
SummaryTrue
Requirements

Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

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

Official Corporate Logo


Mappings
  • rim: ./title/data
DiagnosticReport.presentedForm.creation
DefinitionThe date that the attachment was first created.
Cardinality0...1
TypedateTime
SummaryTrue
Requirements

This is often tracked as an integrity issue for use of the attachment.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A (needs data type R3 proposal)

Attribute list

Attribute Description Example
identifier.value The code that identifies the diagnostic report 'diagnostic-report-example-1'
status The status of the diagnostic report #final
category.coding.code The code showing the type of report SNOMED CT: '#394914008
category.coding.display The textual value showing the type of report 'Radiology'
subject.reference A reference to the patient that the diagnostic report is about 'Patient/patient-1'
effectiveDateTime The date/time that the report was first published in the source system '2013-12-10T08:00:00Z'
performer.reference (Practitioner) A reference to the person who wrote the report 'Practitioner/practitioner-1'
performer.reference (Organization) A reference to the specialism responsible for the report 'Organization/specialism-1'
media.link.reference A reference to the media associated with this report '872154798'
conclusion The full text of the report. This field can be used instead of presentedForm.data 'The patient John Doe has a broken bone.'
presentedForm.data The full text of the report. This field can be used instead of conclusion 'The patient John Doe has a broken bone.'