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This page is part of the FHIRcast (v3.0.0-ballot: STU3 (v3.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

DiagnosticReport-update Event

Event-name: DiagnosticReport-update

eventMaturity 2 - Tested

The DiagnosticReport-update event is used by Subscribers to support content sharing in communication with a Hub which also supports content sharing. A DiagnosticReport-update request will be posted to the Hub when a Subscriber desires to add, change, or remove exchanged information in the anchor context. For a DiagnosticReport-update, the anchor context is the DiagnosticReport context established by the corresponding DiagnosticReport-open. One or more update requests MAY occur while the anchor context is open.

The updates include:

  • adding, updating, or removing FHIR resources contained in the DiagnosticReport
  • updating attribute values of the DiagnosticReport or associated context resources (Patient and/or ImagingStudy resources)

Context

Key Cardinality Description
report 1..1 FHIR DiagnosticReport resource specifying the anchor context in which the update is being made. Note the mandatory elements defined in the DiagnosticReport update profile. Other attributes may be present in the DiagnosticReport resource if their values have changed or were newly populated.
patient 0..1 Present if one or more attributes in the Patient resource associated with the report have changed.
study 0..1 Present if one or more attributes in the ImagingStudy resource associated with the report have changed
updates 1..1 Contains a single Bundle resource holding changes to be made to the current content of the anchor context

The following profiles provide guidance as to which resource attributes should be present and considerations as to how each attribute should be valued in a DiagnosticReport-update request:

Supported Update Request Methods

Each entry in the updates Bundle resource SHALL contain one of the below method values in an entry’s request attribute. No resource SHALL appear multiple times in the updates Bundle. One and only one transaction Bundle SHALL be present in a DiagnosticReport-update request.

Request Method Operation
PUT Add a new resource or update a resource already existing in the content
DELETE Remove an existing resource

Examples

DiagnosticReport-update Request Example

The following example shows adding an imaging study to the existing diagnostic report context and a new observation. The context.versionId matches the context.versionId provided by the Hub in the most recent DiagnosticReport-open or DiagnosticReport-update event. The report key in the context array holds the id of the diagnostic report and is required in all DiagnosticReport-update events. The Bundlein the updates key holds the addition (PUT) of an imaging study and adds (PUT) an observation derived from this study.

{
  "timestamp": "2019-09-10T14:58:45.988Z",
  "id": "cc4d016a-f516-4ce7-8f1a-e0baf0beb94d",
  "event": {
    "hub.topic": "fdb2f928-5546-4f52-87a0-0648e9ded065",
    "hub.event": "DiagnosticReport-update",
    "context.versionId": "b9574cb0-e9e5-4be1-8957-5fcb51ef33c1",
    "context": [
      {
        "key": "report",
        "resource": {
          "resourceType": "DiagnosticReport",
          "id": "2402d3bd-e988-414b-b7f2-4322e86c9327",
          "status": "unknown",
          "code" : {
            "coding" : [
              {
                "system" : "http://loinc.org",
                "code" : "19005-8",
                "display": "Radiology Imaging study [Impression] (narrative)"
              }
            ]
          }
        }
      },
      {
        "key": "updates",
        "resource": {
          "resourceType": "Bundle",
          "type": "transaction",
          "entry": [
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "ImagingStudy",
                "description": "CHEST XRAY",
                "started": "2010-02-14T01:10:00.000Z",
                "id": "7e9deb91-0017-4690-aebd-951cef34aba4",
                "identifier": [
                  {
                    "type": {
                      "coding": [
                        {
                          "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code": "ACSN"
                        }
                      ]
                    },
                    "value": "3478116342"
                  },
                  {
                    "system": "urn:dicom:uid",
                    "value": "urn:oid:2.16.124.113543.6003.1154777499.30276.83661.3632298176"
                  }
                ]
              }
            },
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "Observation",
                "id": "40afe766-3628-4ded-b5bd-925727c013b3",
                "partOf": {
                  "reference": "ImagingStudy/7e9deb91-0017-4690-aebd-951cef34aba4"
                },
                "status": "preliminary",
                "category": {
                  "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                  "code": "imaging",
                  "display": "Imaging"
                },
                "code": {
                  "coding": [
                    {
                      "system": "http://www.radlex.org",
                      "code": "RID49690",
                      "display": "simple cyst"
                    }
                  ] 
                },
                "issued": "2020-09-07T15:02:03.651Z"
              }
            }
          ]
        }
      }
    ]
  }
}
DiagnosticReport-update Event Example

The Hub SHALL distribute a corresponding event to all Subscribers. The Hub SHALL replace the context.versionId in the request with a new context.versionId generated and retained by the Hub. The prior version, context.priorVersionId of the context is also provided to ensure that a Subscriber is currently in sync with the latest context prior to applying the new updates. If the value of context.priorVersionId is not in agreement with the context.versionId last received by a Subscriber, it is recommended that the Subscriber issue a GET request to the Hub in order to retrieve the latest version of the context (note that the GET request returns the context, all existing content, and the current context.versionId).

{
  "timestamp": "2019-09-10T14:58:45.988Z",
  "id": "cc4d016a-f516-4ce7-8f1a-e0baf0beb94d",
   "event": {
    "hub.topic": "fdb2f928-5546-4f52-87a0-0648e9ded065",
    "hub.event": "DiagnosticReport-update",
    "context.versionId": "efcac43a-ed38-49e4-8d79-73f78290292a",
    "context.priorVersionId": "b9574cb0-e9e5-4be1-8957-5fcb51ef33c1",
    "context": [
      {
        "key": "report",
        "resource": {
          "resourceType": "DiagnosticReport",
          "id": "2402d3bd-e988-414b-b7f2-4322e86c9327",
          "status": "unknown",
          "code" : {
            "coding" : [
              {
                "system" : "http://loinc.org",
                "code" : "19005-8",
                "display": "Radiology Imaging study [Impression] (narrative)"
              }
            ]
          }
        }
      },
      {
        "key": "updates",
        "resource": {
          "resourceType": "Bundle",
          "type": "transaction",
          "entry": [
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "ImagingStudy",
                "description": "CHEST XRAY",
                "started": "2010-02-14T01:10:00.000Z",
                "id": "7e9deb91-0017-4690-aebd-951cef34aba4",
                "identifier": [
                  {
                    "type": {
                      "coding": [
                        {
                          "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code": "ACSN"
                        }
                      ]
                    },
                    "value": "3478116342"
                  },
                  {
                    "system": "urn:dicom:uid",
                    "value": "urn:oid:2.16.124.113543.6003.1154777499.30276.83661.3632298176"
                  }
                ]
              }
            },
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "Observation",
                "id": "40afe766-3628-4ded-b5bd-925727c013b3",
                "partOf": {
                  "reference": "ImagingStudy/7e9deb91-0017-4690-aebd-951cef34aba4"
                },
                "status": "preliminary",
                "category": {
                  "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                  "code": "imaging",
                  "display": "Imaging"
                },
                "code": {
                  "coding": [
                    {
                      "system": "http://www.radlex.org",
                      "code": "RID49690",
                      "display": "simple cyst"
                    }
                  ] 
                },
                "issued": "2020-09-07T15:02:03.651Z"
              }
            }
          ]
        }
      }
    ]
  }
}
DiagnosticReport-update Request with DELETE Example

The following example shows a request to delete an observation from a content sharing session.

{
  "timestamp": "2019-09-10T15:02:33.343Z",
  "id": "d30734f1-3c7d-4fe4-a343-fbf4d80faddb",
  "event": {
    "hub.topic": "fdb2f928-5546-4f52-87a0-0648e9ded065",
    "hub.event": "DiagnosticReport-update",
    "context.versionId": "efcac43a-ed38-49e4-8d79-73f78290292a",
    "context": [
      {
        "key": "report",
        "resource": {
          "resourceType": "DiagnosticReport",
          "id": "2402d3bd-e988-414b-b7f2-4322e86c9327",
          "status": "unknown",
          "code" : {
            "coding" : [
              {
                "system" : "http://loinc.org",
                "code" : "19005-8",
                "display": "Radiology Imaging study [Impression] (narrative)"
              }
            ]
          }
        }
      },
      {
        "key": "updates",
        "resource": {
          "resourceType": "Bundle",
          "type": "transaction",
          "entry": [
            {
              "fullUrl": "Observation/40afe766-3628-4ded-b5bd-925727c013b3"
              "request": {
                "method": "DELETE"
              }
            }
          ]
        }
      }
    ]
  }
}

Change Log

Version Description
0.1 Initial draft
1.0 Updated for STU3