Pan-Canadian Patient Summary (2.2.0-ti-ballot)
2.2.0-ti-ballot 
ti-ballot - For a full list of available versions, see the Directory of published versions
DiagnosticReport (PS-CA)
Links
Profile
Derived from
http://hl7.org/fhir/StructureDefinition/DiagnosticReport
Examples
Description
This profile represents the constraints applied to the DiagnosticReport resource by the PS-CA project to represent diagnostic test and procedure reports in a patient summary. It allows for cross-border and cross-jurisdiction sharing of Diagnostic Result information.
References to this resource
Resource Content
| DiagnosticReportPSCA (DiagnosticReport) | C | DiagnosticReport | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| basedOn | C | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) |
| status | Σ ?! | 1..1 | codeBinding |
| category | Σ | 0..* | CodeableConceptPSCA |
| code | SO Σ | 1..1 | CodeableConceptPSCABinding |
| subject | SO Σ C | 1..1 | Reference(PatientPSCA | Group) |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| reference | SO Σ C | 1..1 | string |
| type | Σ | 0..1 | uriBinding |
| identifier | Σ | 0..1 | Identifier |
| display | Σ | 0..1 | string |
| encounter | Σ C | 0..1 | Reference(Encounter) |
| effective[x] | SO Σ | 1..1 | |
| effectiveDateTime | dateTime | ||
| effectivePeriod | Period | ||
| issued | Σ | 0..1 | instant |
| performer | SO Σ C | 0..* | Reference(OrganizationLabPSCA | PractitionerLabPSCA | PractitionerRoleLabPSCA | CareTeam) |
| resultsInterpreter | Σ C | 0..* | Reference(CareTeam | Organization | Practitioner | PractitionerRole) |
| specimen | C | 0..* | Reference(Specimen) |
| result | SO C | 0..* | Reference(Observation) |
| observation-results | C | 0..* | Reference(ObservationResultsLaboratoryPathologyPSCA | ObservationResultsRadiologyPSCA) |
| imagingStudy | C | 0..* | Reference(ImagingStudy) |
| media | Σ | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| comment | 0..1 | string | |
| link | Σ C | 1..1 | Reference(Media) |
| conclusion | 0..1 | string | |
| conclusionCode | 0..* | CodeableConcept | |
| presentedForm | C | 0..* | Attachment |
| DiagnosticReportPSCA (DiagnosticReport) | C | DiagnosticReport | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| basedOn | C | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) |
| status | Σ ?! | 1..1 | codeBinding |
| category | Σ | 0..* | CodeableConceptPSCA |
| code | SO Σ | 1..1 | CodeableConceptPSCABinding |
| subject | SO Σ C | 1..1 | Reference(PatientPSCA | Group) |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| reference | SO Σ C | 1..1 | string |
| type | Σ | 0..1 | uriBinding |
| identifier | Σ | 0..1 | Identifier |
| display | Σ | 0..1 | string |
| encounter | Σ C | 0..1 | Reference(Encounter) |
| effective[x] | SO Σ | 1..1 | |
| effectiveDateTime | dateTime | ||
| effectivePeriod | Period | ||
| issued | Σ | 0..1 | instant |
| performer | SO Σ C | 0..* | Reference(OrganizationLabPSCA | PractitionerLabPSCA | PractitionerRoleLabPSCA | CareTeam) |
| resultsInterpreter | Σ C | 0..* | Reference(CareTeam | Organization | Practitioner | PractitionerRole) |
| specimen | C | 0..* | Reference(Specimen) |
| result | SO C | 0..* | Reference(Observation) |
| observation-results | C | 0..* | Reference(ObservationResultsLaboratoryPathologyPSCA | ObservationResultsRadiologyPSCA) |
| imagingStudy | C | 0..* | Reference(ImagingStudy) |
| media | Σ | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| comment | 0..1 | string | |
| link | Σ C | 1..1 | Reference(Media) |
| conclusion | 0..1 | string | |
| conclusionCode | 0..* | CodeableConcept | |
| presentedForm | C | 0..* | Attachment |
<description value="This profile represents the constraints applied to the DiagnosticReport resource by the PS-CA project to represent diagnostic test and procedure reports in a patient summary. It allows for cross-border and cross-jurisdiction sharing of Diagnostic Result information." />
<copyright value="Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." />
<short value="A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports" />
<definition value="The 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." />
<comment value="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." />
</base>
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
</constraint>
<human value="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" />
<expression value="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()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
</constraint>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
</base>
</extension>
</type>
</element>
<definition value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
</mapping>
</element>
<comment value="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)." />
</base>
</type>
</constraint>
</extension>
</extension>
</binding>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</mapping>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
</mapping>
</mapping>
</element>
<comment value="Usually assigned by the Information System of the diagnostic service provider (filler id)." />
<requirements value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="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]" />
</mapping>
</mapping>
</mapping>
</mapping>
<map value="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" />
</mapping>
</mapping>
</element>
<comment value="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." />
<requirements value="This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon." />
</base>
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<requirements value="Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
</extension>
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"" />
</mapping>
</element>
<definition value="A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text." />
<comment value="For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code" />
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text." />
<comment value="For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
</constraint>
</extension>
<description value="Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. A stub value set pointing to pCLOCD code system is put forth in the meantime to encourage implementers to utilize the Canadian localization of LOINC" />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)" />
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="The 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." />
<comment value="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." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" />
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources." />
<comment value="Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources)." />
<comment value="This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
</element>
<definition value="An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference." />
<comment value="When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="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]" />
</mapping>
</mapping>
</mapping>
</element>
</extension>
<definition value="Plain text narrative that identifies the resource in addition to the resource reference." />
<comment value="This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about." />
<comment value="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)." />
</base>
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="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." />
<comment value="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." />
</base>
</type>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<comment value="The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance" />
<requirements value="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." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitioner-lab-ca-ps" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitionerrole-lab-ca-ps" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/organization-lab-ca-ps" />
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The practitioner or organization that is responsible for the report's conclusions and interpretations." />
<requirements value="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." />
</base>
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="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." />
<requirements value="Need to be able to report information about the collected specimens on which the report is based." />
</base>
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</discriminator>
</slicing>
<comment value="The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance" />
<requirements value="Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful." />
</base>
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<requirements value="Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-laboratory-pathology-ca-ps" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps" />
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="A 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)." />
<requirements value="Many diagnostic services include images in the report as part of their service." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</mapping>
</element>
<definition value="A 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." />
<comment value="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." />
<requirements value="The provider of the report should make a comment about each image included in the report." />
</base>
</type>
</constraint>
</mapping>
<map value=".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value" />
</mapping>
</element>
<comment value="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." />
</base>
</type>
</constraint>
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report." />
<requirements value="Need to be able to provide a conclusion that is not lost among the basic result data." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)" />
</mapping>
</element>
<definition value="One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report." />
<comment value="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." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)" />
</mapping>
</element>
<definition value="Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent." />
<comment value=""application/pdf" is recommended as the most reliable and interoperable in this context." />
<requirements value="Gives laboratory the ability to provide its own fully formatted report for clinical fidelity." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</snapshot>
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
<description value="Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. A stub value set pointing to pCLOCD code system is put forth in the meantime to encourage implementers to utilize the Canadian localization of LOINC" />
</binding>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" />
</type>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<comment value="The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitioner-lab-ca-ps" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitionerrole-lab-ca-ps" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/organization-lab-ca-ps" />
</type>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</discriminator>
</slicing>
<comment value="The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance" />
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-laboratory-pathology-ca-ps" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps" />
</type>
</element>
</differential>
</StructureDefinition>
{
"description": "This profile represents the constraints applied to the DiagnosticReport resource by the PS-CA project to represent diagnostic test and procedure reports in a patient summary. It allows for cross-border and cross-jurisdiction sharing of Diagnostic Result information.",
"copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
{
"short": "A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports",
"definition": "The 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.",
"comment": "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.",
"Report",
"Test",
"Result",
"Results",
"Labs",
"Laboratory"
],
},
{
},
{
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
},
{
"human": "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",
"expression": "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()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
},
{
{
},
{
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
},
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
},
{
{
}
],
}
],
},
{
"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.",
},
],
"ele-1"
],
{
}
],
]
},
{
"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.",
"comment": "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.",
},
],
"ele-1"
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
]
},
{
"comment": "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).",
},
],
"ele-1"
],
{
}
],
{
},
{
}
],
},
]
},
{
"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.",
"comment": "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.",
"narrative",
"html",
"xhtml",
"display"
],
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
}
]
},
{
"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.",
"comment": "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.",
"inline resources",
"anonymous resources",
"contained resources"
],
},
],
]
},
{
],
},
"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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
]
},
{
],
},
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
]
},
{
"comment": "Usually assigned by the Information System of the diagnostic service provider (filler 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.",
"ReportID",
"Filler ID",
"Placer ID"
],
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
"map": "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]"
},
{
},
{
},
{
},
{
"map": "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"
},
{
}
]
},
{
"comment": "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.",
"requirements": "This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.",
"Request"
],
},
{
"http://hl7.org/fhir/StructureDefinition/CarePlan",
"http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation",
"http://hl7.org/fhir/StructureDefinition/MedicationRequest",
"http://hl7.org/fhir/StructureDefinition/NutritionOrder",
"http://hl7.org/fhir/StructureDefinition/ServiceRequest"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
},
{
}
]
},
{
"requirements": "Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.",
},
],
"ele-1"
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
{
}
],
},
{
},
{
},
{
},
{
},
{
"map": "statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type \"revise\""
}
]
},
{
"definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
"comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
"Department",
"Sub-department",
"Service",
"Discipline"
],
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
"ele-1"
],
{
}
],
{
}
],
},
{
},
{
},
{
},
{
},
{
},
{
},
{
"map": "inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code"
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
"comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
"Type"
],
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
"ele-1"
],
{
}
],
{
}
],
"description": "Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. A stub value set pointing to pCLOCD code system is put forth in the meantime to encourage implementers to utilize the Canadian localization of LOINC",
},
{
},
{
},
{
},
{
},
{
},
{
},
{
"map": "OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)"
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "The 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.",
"comment": "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.",
"Patient"
],
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps",
"http://hl7.org/fhir/StructureDefinition/Group"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
},
],
"ele-1",
"ref-1"
],
{
}
],
]
},
{
"definition": "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).",
"comment": "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.",
},
],
"ele-1"
],
{
}
],
{
}
],
},
]
},
{
"definition": "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).",
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
"map": "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]"
},
{
},
{
}
]
},
{
{
}
],
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
},
],
"ele-1"
],
{
}
],
]
},
{
"definition": "The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.",
"comment": "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).",
"Context"
],
},
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"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.",
"comment": "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.",
"Observation time",
"Effective Time",
"Occurrence"
],
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
},
{
},
{
}
]
},
{
"definition": "The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.",
"comment": "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.",
"Date published",
"Date Issued",
"Date Verified"
],
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"comment": "The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance",
"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.",
"Laboratory",
"Service",
"Practitioner",
"Department",
"Company",
"Authorized by",
"Director"
],
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitioner-lab-ca-ps",
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitionerrole-lab-ca-ps",
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/organization-lab-ca-ps",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"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.",
"Analyzed by",
"Reported by"
],
},
{
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"comment": "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.",
"requirements": "Need to be able to report information about the collected specimens on which the report is based.",
},
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
"comment": "The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance",
"requirements": "Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.",
"Data",
"Atomic Value",
"Result",
"Atomic result",
"Data",
"Test",
"Analyte",
"Battery",
"Organizer"
],
},
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
}
]
},
{
"requirements": "Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.",
"Data",
"Atomic Value",
"Result",
"Atomic result",
"Data",
"Test",
"Analyte",
"Battery",
"Organizer"
],
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-laboratory-pathology-ca-ps",
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
}
]
},
{
"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.",
"comment": "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.",
},
{
}
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
}
]
},
{
"definition": "A 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).",
"DICOM",
"Slides",
"Scans"
],
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
]
},
{
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
"ele-1"
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
"definition": "A 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.",
"comment": "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.",
"requirements": "The provider of the report should make a comment about each image included in the report.",
},
],
"ele-1"
],
{
}
],
{
},
{
"map": ".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value"
}
]
},
{
"comment": "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.",
},
],
"ele-1"
],
{
},
{
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
}
]
},
{
"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.",
"Report"
],
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
"map": "inboundRelationship[typeCode=\"SPRT\"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)"
}
]
},
{
"definition": "One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.",
"comment": "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.",
},
],
"ele-1"
],
{
}
],
{
}
],
},
{
},
{
},
{
},
{
},
{
},
{
"map": "inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)"
}
]
},
{
"definition": "Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.",
"comment": "\"application/pdf\" is recommended as the most reliable and interoperable in this context.",
"requirements": "Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.",
},
],
"ele-1"
],
{
},
{
}
],
{
},
{
},
{
},
{
},
{
}
]
}
]
},
{
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
"description": "Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. A stub value set pointing to pCLOCD code system is put forth in the meantime to encourage implementers to utilize the Canadian localization of LOINC",
}
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps",
"http://hl7.org/fhir/StructureDefinition/Group"
]
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"comment": "The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance",
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitioner-lab-ca-ps",
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitionerrole-lab-ca-ps",
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/organization-lab-ca-ps",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
"comment": "The IPS-UV specification considers this a Must Support element. Further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance",
},
{
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-laboratory-pathology-ca-ps",
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps"
]
}
]
}
]
}
}
Terminology bindings (Differential)
| Path | Conformance | ValueSet |
|---|---|---|
| DiagnosticReport.code | preferred | http://fhir.infoway-inforoute.ca/io/psca/ValueSet/pCLOCD |
Terminology bindings (Snapshot)
| Path | Conformance | ValueSet |
|---|---|---|
| DiagnosticReport.language | preferred | http://hl7.org/fhir/ValueSet/languages |
| DiagnosticReport.status | required | http://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1 |
| DiagnosticReport.category | example | http://hl7.org/fhir/ValueSet/diagnostic-service-sections |
| DiagnosticReport.code | preferred | http://fhir.infoway-inforoute.ca/io/psca/ValueSet/pCLOCD |
| DiagnosticReport.subject.type | extensible | http://hl7.org/fhir/ValueSet/resource-types |
| DiagnosticReport.conclusionCode | example | http://hl7.org/fhir/ValueSet/clinical-findings |
Constraints
Key Differences between the IPS-UV and PS-CA
Must Support Differences:
Both IPS and PS-CA have Must Support on
DiagnosticReport.effective[x]but IPS has additional Must Support and Obligation expectations onDiagnosticReport.effective[x].effectiveDateTimewhile PS-CA does notPS-CA applies Must Support and Obligations on
DiagnosticReport.resultswhile IPS applies them specifically on theobservation-resultsslice ofDiagnosticReport.results.
Cardinality Differences:
There are no cardinality differences between this profile and IPS-UV
Vocabulary Differences:
There are no vocabulary differences between this profile and IPS-UV
Other differences between the IPS and PS-CA Include:
- Data type profiles (e.g., CodeableConcept) and reference targets (e.g., Patient) replaced with PS-CA equivalents when appropriate