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10.0 Diagnostic Medicine Module

10.0.1 Introduction

The Diagnostics Module provides an overview and guide to the FHIR content that addresses ordering and reporting of clinical diagnostics including laboratory testing, imaging and genomics.

10.0.2 Index

The Diagnostics module covers the following resources:

Observation DiagnosticReport DiagnosticRequest

ImagingStudy ImagingManifest Sequence

Specimen BodySite

The diagnostic resources and their relationships are shown below. The Arrows represent the direction of the references between resources. For example, DiagnosticReport references DiagnosticRequest.

Also, see the Genomics Implementation Guidance for additional information about how to use the Diagnostic resources for Clinical Genomic Reporting and Analysis.

10.0.3 Security and Privacy

The diagnostic resources often represent patient-related data, and as such are susceptible to data breaching. Necessary privacy and security provision must be in place for searching and fetching this information. For more general considerations, see the Security and Privacy module.

10.0.4 Common use Cases

Diagnostic resources are commonly used as to order and report clinical diagnostics:

• Ordering a Laboratory Test such as a lipid panel
• Reporting a Laboratory Test such as a lipid panel
• Ordering an imaging study such as a CT study
• Reporting an imaging study such as a CT study
• Ordering a genetics test such as a CT study
• Reporting a genetics test such as HLA genotyping

There are many ways to use these resources independently as well. The Observation resource in particular is central to capturing many measurements and events in healthcare and is often used outside the context of diagnostic orders and reports.

• recording vital signs such as temperature
• recording other observations such as patient's social history like tobacco use
• recording other characteristics of subject such as pregnancy status
• recording clinical assessment tool scores such as an Apgar score.
• identifying and describing a specimen or body site

10.0.5 Developmental Roadmap

• The Observation and Diagnostic Report resources have been tested and used in production tooling and as such have reached a maturity level (FMM) where changes become less likely.
• The ImagingStudy resource has had some limited testing and use. Further use of this resource in production tooling in order for it to reach a more stable FMM level.

These other diagnostic resources are still under development:

• DiagnosticRequest: used in the HL7 production tooling and in several implementation guides. As a result of the addition of FHIR workflow for STU3, the DiagnosticRequest resources has undergone substantial changes since DSTU2. It has been renamed from DiagnosticOrder and its structure and content updated to align with a general "request" pattern. Because of this, it remains an immature resource.
• Specimen: We expect to see more widespread use of this resource and future updates to its FMM level
• ImagingManifest: We expect to see more widespread use of this resource and future updates to its FMM level
• Sequence: This resource remains draft and we expect to see more widespread use of this resource and future updates to its FMM level
• BodySite: This resource remains draft and its whether it remains a FHIR core resource is still uncertain. It can only be referenced using extensions.

Editor : Eric Haas