DSTU2 Ballot Source

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4.20.17 U.S. Data Access Framework (DAF) Lab Results Profile (Profile)

4.20.17.1 Scope and Usage

This profile sets expectations for use of the Observation resource to record lab results associated with a patient within the Data Access Framework (DAF) Implementation Guide. This profile identifies which core elements, extensions, vocabularies and value sets must be Supported by DAF actors. For the definition of Supported please refer to DAF FHIR IG. The data elements identified by the profile are based on ONC 2014 Edition S&CC and DAF use cases.

Six Observation profiles are defined to cover the various kinds of result values that are generated by laboratories and Ask at Order entry ('AOE') questions. These profiles are:

  • DAFObsCoded for coded results. For example, this profile would be used to record a Chlamydia trachomatis RNA PCR result of "Not Detected"
  • DAFObsQuantity for quantitative or numeric results with required units and reference ranges. For example, this profile would be used to record a Blood Glucose level measurement of 80 mg/dL.
  • DAFObsRange for quantitative results that are expressed as ranges with required reference ranges. For example, this profile would be used to record white blood cells (WBCs) in a urine analysis with a value range of 10-20 WBC/HPF.
  • DAFObsRatio for titers with required reference ranges. For example, this profile would be used to record an adenovirus total antibody of <1:8
  • DAFObsOther for the remaining result value datatypes
    • Attachment
    • dateTime
    • Period
    • SampleData
    • string
    • time
    For example, this profile would be used to record a free text entry of a cytology observation, or to record the date of last menstrual period for an ask at order entry question for a pap smear report.
  • DAFObsPanel for a panel/battery. This observation lists the set component observations from a panel or battery in the Observation.related element and does not have its own Observation.value. For example a Chyamydia trachomatis + Neisseria gonorrhoeae RNA PCR (GC/CT) panel would have two references to related observations for the Chlamydia trachomatis RNA PCR result and the Neisseria gonorrhoeae RNA PCR result.

These profile are referenced in the DAF DiagnosticReport profile for one or more lab test results. They are also referenced for ask at order ("AOE") questions, other clinically relevant questions and for reporting prior results when requesting a test order using the DAF DiagnosticOrder. Although not specified in this implementation, it may be used in other resources as well.

The mappings between the ONC 2014 Edition S&CC data elements and DAF data elements are captured in the table below, where the first column identifies the ONC 2014 Edition S&CC data element name, the second column maps the ONC 2014 Edition S&CC data elements to DAF data elements which are derived from ONC 2014 Edition S&CC standards and DAF use cases and lastly the third column identifies the mapping to FHIR resources and attributes.

4.20.17.2 Meaningful Use Data Element Mapping

The DAFResults profile mapping to Meaningful Use data elements and FHIR Resources are as shown below.


Meaningful Use Data Element Name Mapping to Priority DAF Data Elements FHIR Resource Mapping
Laboratory Result Value(s)
Lab Test Name Observation.name.coding.code
Lab Test Result Observation.value[x](Code,Quantity,Ratio or other)
Lab Test Specimen collection date Observation.applies[x]
Lab Test Result Available Date Observation.issued
Lab Test Result Interpretation Observation.interpretation
Lab Test Result Reference Range Observation.referenceRange
Body Site used to collect specimen Observation.bodySite[x]

4.20.17.3 Boundaries and Relationships

This profile relies on the following other profiles:

  • DAFPatient which defines DAF Patient profile is used by DAF Result profiles to refer to patients.
  • FHIR Extensibility defines how extensions can be applied to FHIR resources and data types. Specifically the data-absent-reason extension can be used to code data elements with missing information when appropriate. See DAF FHIR IG for additional guidance.

4.20.17.4 Content

Profiles:
DAFResultObsCodeUS Realm DAF laboratory result using CodeableConcept Data Type for non-numeric results
DAFResultObsQuantityUS Realm DAF laboratory result using Quantity Data Type for numeric results
DAFResultObsRangeUS Realm DAF laboratory result using Range Data Type for numeric results
DAFResultObsRatioUS Realm DAF laboratory result using Ratio Data Type for numeric results
DAFResultObsOtherUS Realm DAF laboratory result using one of Attachment|dateTime|Period|SampledData|string|timeData Type for results.
DAFResultObsPanelUS Realm DAF laboratory panel observation

4.20.17.4.1 Search Parameters

The full list of supported search parameters are can be accessed at DAF Requestor conformance expectations and DAF Responder conformance expectations.

4.20.17.4.2 Example Usage Scenarios

The following are example usage scenarios for the DAFResults profile:

  • Query for lab results belonging to a Patient
  • Query for all patients who have had a specific lab test result available
  • Query for lab results based on type of lab test
  • Query for all patients with a lab test (e.g hba1c) beyond the acceptable reference range

4.20.17.4.3 Profile specific implementation guidance

Implementers need to be mindful of the following during their implementation

    Using Right DAF Result profile: Implementers are advised to use the right DAFResult profile based on the value to be represented. For example, in case the value element is a codeableConcept implementers should use DAFResultObservationCode profile. Similarly for representing Quantity, Ratio and Other types of results the appropriate DAFResult profile listed above should be used.

    Representing No Known Lab Results: No Known Lab Results will be represented using the DAFResultsList profile with no entries.

    See DAF FHIR IG for implementation guidance common to all profiles.