2nd DSTU Draft For Comment
This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
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An example of a complex Micro Isolate and Sensitivities (id = "micro")
<DiagnosticReport xmlns="http://hl7.org/fhir"> <id value="micro"/> <!-- This diagnostic report shows how to do a microbiology isolate and sensitivity. This is a particular complex case, with two different susceptibilities. The basic structure of the report is DiagnosticReport - metadata group - base group, code that says, ICS group - organism = Staphylococcus aureus. You'd repeat at this level if you had more than one organism group - automated broth dilution results = sensitivities group - Disk diffusion results = sensitivities Note, then, that the organism appears in the group code, not a result code. This diagnostic report was developed from this example HL7 v2 message: OBR|1|255337816|290741144^HNAM_ORDERID-MRSACULT-^HNAM_ORDERID|MRSACULT^Culture, MRSA^^632-0^Culture, MRSA|||20090807190000|||101022^Unit|||Y|2009080800|Wound^^Right hand wound^Hand R|00013442^ASHBY^TOD D^R^^^PA||||000002009219104402^HNA_ACCN~21619128^HNA_ACCNID||20090810082544||MB|F||1^^^20090808040954 ^^R~^^^^^R|||||||||20090807195000|||||||||||||||| OBX|4|CE|ORGANISM|1|Staaur^Staphylococcus aureus^Staaur|||||A~S|F|||||^10304| OBX|5|CE|CULTPOSNEG||POS|||POS|||F|||||| OBR|2|xxxxx|xxxxxxx|60790^Susceptibility - Automated broth dilution (Billed)|||20120911072700||20025 57|xxx||||2012091100||xxxxx||||000002012255101033^xxxxx||20120914165737||MB|F|^1^Staaur&Staphyloc occus aureus&310783|1^^^20120911142558^^R~^^^^^R||60108||||||||||||||||||||||| OBX|1|ST|60504^Ampicillin&AST Interp|1|Resistant|||RESIST||A~S|F||N|||^9315| OBX|2|ST|60512^Cefazolin&AST Dilutn|1|<=2|||SUSCEPT||A~S|F||N|||^9315| OBX|3|ST|60512^Cefazolin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315| OBX|4|ST|60516^Cefoxitin&AST Dilutn|1|<=4|||SUSCEPT||A~S|F||N|||^9315| OBX|5|ST|60516^Cefoxitin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315| OBX|6|ST|60527^Clindamycin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315| OBX|7|ST|60527^Clindamycin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|8|ST|61203^Daptomycin&AST Dilutn|1|<=1|||SUSCEPT||A~S|F||Y|||^9315| OBX|9|ST|61203^Daptomycin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|10|ST|60532^Doxycycline&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||N|||^9315| OBX|11|ST|60532^Doxycycline&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315| OBX|12|ST|60533^Erythromycin&AST Dilutn|1|>=8|||RESIST||A~S|F||Y|||^9315| OBX|13|ST|60533^Erythromycin&AST Interp|1|Resistant|||RESIST||A~S|F||Y|||^9315| OBX|14|ST|60536^Gentamicin&AST Dilutn|1|<=2|||SUSCEPT||A~S|F||Y|||^9315| OBX|15|ST|60536^Gentamicin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|16|ST|61007^Levofloxacin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315| OBX|17|ST|61007^Levofloxacin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|18|NM|60699^Linezolid&AST Dilutn|1|4|||SUSCEPT||A~S|F||Y|||^9315| OBX|19|ST|60699^Linezolid&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|20|ST|61204^Moxifloxacin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||N|||^9315| OBX|21|ST|61204^Moxifloxacin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315| OBX|22|NM|60551^Oxacillin&AST Dilutn|1|0.5|||SUSCEPT||A~S|F||Y|||^9315| OBX|23|ST|60551^Oxacillin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|24|ST|60552^Penicillin&AST Dilutn|1|>=2|||RESIST||A~S|F||Y|||^9315| OBX|25|ST|60552^Penicillin&AST Interp|1|Resistant|||RESIST||A~S|F||Y|||^9315| OBX|26|ST|60697^Quinupristin/Dalfopristin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315| OBX|27|ST|60697^Quinupristin/Dalfopristin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|28|ST|60555^Rifampin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315| OBX|29|ST|60555^Rifampin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|30|ST|60558^Tetracycline&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315| OBX|31|ST|60558^Tetracycline&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|32|ST|60561^Trimethoprim/Sulfamethoxazole&AST Dilutn|1|<=1/19|||SUSCEPT||A~S|F||Y|||^9315 | OBX|33|ST|60561^Trimethoprim/Sulfamethoxazole&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^93 15| OBX|34|NM|60563^Vancomycin&AST Dilutn|1|1|||SUSCEPT||A~S|F||Y|||^9315| OBX|35|ST|60563^Vancomycin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| OBX|36|ST|60500^Susceptibilities Performed&AST Dilutn|1|Performed|||||A~S|F||N|||^9315| OBX|37|ST|60500^Susceptibilities Performed&AST Interp|1|Completed|||||A~S|F||N|||^9315| OBX|38|ST|2099930^D-Test&AST Interp|1|See Note|||||A~S|F||Y|||^9315| OBX|39|ST|2099935^Interpretative Information&AST Interp|1|See Note|||||A~S|F||Y|||^9315| NTE|1|L|D-Test: Negative - This isolate does not demonstrate| NTE|2|L|inducible clindamycin resistance in vitro.| OBR|3|xxxx|xxxxxxx|60418^Susceptibility - Disk diffusion (Billed)|||20120911072700|||xxxxx||||201209 1100||xxxxx||||000002012255101033^xxxxxx||20120914165737||MB|F|^1^Staaur&Staphylococcus aureus&310783|1^^^20120911142558^^R~^^^^^R||60108||||||||||||||||||||||| OBX|1|ST|60036^Oxacillin Screen&KB Zone|1|60416|||SUSCEPT||A~S|F||N|||^9315| OBX|2|ST|60036^Oxacillin Screen&KB Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315| --> <!-- first, a series of atomic results matching the atomice result OBXs --> <contained> <Observation> <id value="obx1-4"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="ORGANISM"/> </coding> </code> <valueCodeableConcept> <!-- CE --> <coding> <system value="http://acme.org/lab/codes/organisms"/> <code value="Staaur"/> </coding> <text value="Staphylococcus aureus"/> </valueCodeableConcept> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx1-5"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="CULTPOSNEG"/> </coding> </code> <valueCodeableConcept> <coding> <system value="http://acme.org/lab/codes/flags"/> <code value="POS"/> </coding> </valueCodeableConcept> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <!-- this is an interpretation without a value, as in the source message. Quite Strange --> <contained> <Observation> <id value="obx2-1"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="60504"/> <display value="Ampicillin"/> </coding> </code> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="R"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-2"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="60512"/> <display value="Cefazolin"/> </coding> </code> <valueQuantity> <value value="2"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-4"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="60516"/> <display value="Cefoxitin"/> </coding> </code> <valueQuantity> <value value="4"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-6"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="60527"/> <display value="Clindamycin"/> </coding> </code> <valueQuantity> <value value="0.5"/> <comparator value=">="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-8"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="61203"/> <display value="Daptomycin"/> </coding> </code> <valueQuantity> <value value="1"/> <comparator value=">="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-10"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60532"/> <display value="Doxycycline"/> </coding> </code> <valueQuantity> <value value="0.5"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-12"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60533"/> <display value="Erythromycin"/> </coding> </code> <valueQuantity> <value value="8"/> <comparator value=">="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="R"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-14"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60536"/> <display value="Gentamicin"/> </coding> </code> <valueQuantity> <value value="2"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-16"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 61007"/> <display value="Levofloxacin"/> </coding> </code> <valueQuantity> <value value="0.5"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-18"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60699"/> <display value="Linezolid"/> </coding> </code> <valueQuantity> <value value="4"/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-20"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 61204"/> <display value="Moxifloxacin"/> </coding> </code> <valueQuantity> <value value="0.5"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-22"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60551"/> <display value="Oxacillin"/> </coding> </code> <valueQuantity> <value value="0.5"/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-24"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60552"/> <display value="Penicillin"/> </coding> </code> <valueQuantity> <value value="2"/> <comparator value=">="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="R"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-26"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60697"/> <display value="Quinupristin/Dalfopristin"/> </coding> </code> <valueQuantity> <value value="0.5"/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-28"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60555"/> <display value="Rifampin"/> </coding> </code> <valueQuantity> <value value="0.5"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-30"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60558"/> <display value="Tetracycline"/> </coding> </code> <valueQuantity> <value value="0.5"/> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-32"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60561"/> <display value="Trimethoprim/Sulfamethoxazole"/> </coding> </code> <valueQuantity> <value value="0.0526"/> <!-- not sure what to do with <=1/19 --> <comparator value="<="/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx2-34"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value=" 60563"/> <display value="Vancomycin"/> </coding> </code> <valueQuantity> <value value="1"/> </valueQuantity> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="nte-1"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="2099930"/> <display value="D-Test"/> </coding> </code> <valueString value="D-Test: Negative - This isolate does not demonstrate inducible clindamycin resistance in vitro."/> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <contained> <Observation> <id value="obx3-1"/> <code> <coding> <system value="http://acme.org/lab/codes/tests"/> <code value="60036"/> <display value="Oxacillin"/> </coding> </code> <interpretation> <coding> <system value="http://hl7.org/fhir/v2/0078"/> <code value="S"/> </coding> </interpretation> <status value="final"/> <reliability value="ok"/> </Observation> </contained> <!-- now, nested observations for the groups/panels we're working bottom to top, so first we encounter an inner group: susceptibility measured by broth dilution Note that we don't have to work bottom to top - the contained resources can appear in any order, but since the root does have to appear last, we weill work up to it --> <contained> <Observation> <id value="obr-2"/> <!-- OBR 2 --> <code> <coding> <system value="http://acme.org/lab/codes/panels"/> <code value="60790"/> <display value="Susceptibility - Automated broth dilution (Billed)"/> </coding> </code> <status value="final"/> <reliability value="ok"/> <!-- now, references to the OBXs. for reader convenience, we take keep the OBX identification, though this is not required in practice. Note that many of the oBX segments are pairs that get collapsed --> <related> <type value="has-member"/> <target> <reference value="#obx2-1"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-2"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-4"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-6"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-8"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-10"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-12"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-14"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-16"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-18"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-20"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-22"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-24"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-26"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-28"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-30"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-32"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx2-34"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#nte-1"/> </target> </related> </Observation> </contained> <!-- now we encounter another inner group: susceptibility measured by disk diffusion --> <contained> <Observation> <id value="obr-3"/> <!-- OBR 3 --> <code> <coding> <system value="http://acme.org/lab/codes/panels"/> <code value="60418"/> <display value="Susceptibility - Disk diffusion (Billed)"/> </coding> </code> <status value="final"/> <reliability value="ok"/> <related> <type value="has-member"/> <target> <reference value="#obx3-1"/> </target> </related> </Observation> </contained> <!-- organism group: Staphylococcus aureus. You'd repeat at this level if you had more than one organism --> <contained> <Observation> <id value="org1"/> <!-- OBR 1 --> <code> <coding> <system value="http://acme.org/lab/codes/organisms"/> <code value="Staaur"/> </coding> <text value="Staphylococcus aureus Panel"/> </code> <status value="final"/> <reliability value="ok"/> <related> <type value="has-member"/> <target> <reference value="#obx1-4"/> </target> </related> <related> <type value="has-member"/> <target> <reference value="#obx1-5"/> </target> </related> <!-- group - automated broth dilution. This is unusual - usually, there's just one level of group, and this group would be skipped --> <related> <type value="has-member"/> <target> <reference value="#obr-2"/> </target> </related> <!-- group - Disk diffusion --> <related> <type value="has-member"/> <target> <reference value="#obr-3"/> </target> </related> </Observation> </contained> <!-- ORC information --> <contained> <DiagnosticOrder> <id value="req"/> <subject> <reference value="Patient/101"/> <!-- patient chosen at random --> </subject> <identifier> <value value="255337816"/> </identifier> </DiagnosticOrder> </contained> <!-- start of the main resource --> <name> <coding> <system value="http://loinc.org"/> <code value="632-0"/> </coding> <text value="Culture, MRSA"/> </name> <status value="final"/> <issued value="2009-08-10T08:25:44+10:00"/> <subject> <reference value="Patient/example"/> <!-- patient chosen at random --> </subject> <performer> <display value="Todd Ashby"/> <!-- of course, in practive, this would be a real reference --> </performer> <identifier> <system value="http://hnam.org/identifiers/orders"/> <!-- seems like a likely choice --> <value value="290741144"/> </identifier> <requestDetail> <reference value="#req"/> </requestDetail> <serviceCategory> <coding> <system value="http://hl7.org/fhir/v2/0074"/> <code value="MB"/> </coding> </serviceCategory> <diagnosticDateTime value="2009-08-07T19:00:00+10:00"/> <result> <reference value="#org1"/> </result> </DiagnosticReport>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
© HL7.org 2011+. FHIR DSTU (v0.4.0-4167) generated on Mon, Feb 23, 2015 09:20+1100.
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