Generated Narrative: StructureDefinition profile-DiagnosticReport Name Flags Card. Type Description & Constraints DiagnosticReport 0..* DiagnosticReport A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:resultsInterpreter 0..* Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R5.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole | Cross-version Profile for R5.Organization for use in FHIR STU3(0.1.0) | Organization | Cross-version Profile for R5.CareTeam for use in FHIR STU3(0.1.0) | CareTeam) R5: Primary result interpreter (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.resultsInterpreter #xD; extension:note 0..* Annotation R5: Comments about the diagnostic report (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note #xD; extension:study 0..* Reference(Cross-version Profile for R5.GenomicStudy for use in FHIR STU3(0.1.0) | Basic | Cross-version Profile for R5.ImagingStudy for use in FHIR STU3(0.1.0) | ImagingStudy) R5: Reference to full details of an analysis associated with the diagnostic report (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.study #xD; extension:supportingInfo 0..* (Complex) R5: Additional information supporting the diagnostic report (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.supportingInfo #xD; extension:composition 0..1 Reference(Cross-version Profile for R5.Composition for use in FHIR STU3(0.1.0) | Composition) R5: Reference to a Composition resource for the DiagnosticReport structure (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition #xD; basedOn #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:basedOn 0..* ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: basedOn URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; status #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:status 0..1 code R5: registered | partial | preliminary | modified | final | amended | corrected | appended | cancelled | entered-in-error | unknown additional codes URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.status Binding: DiagnosticReportStatus (required): The status of the diagnostic report. #xD; subject #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:subject 0..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; context #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:encounter 0..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: encounter additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; specimen #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:specimen 0..* ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: specimen additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; result #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:result 0..* ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: Observations additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; image #xD; link #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:link 0..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: Reference to the image or data source additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; Documentation for this format
Cross-version Profile for R5.DiagnosticReport for use in FHIR STU3
This cross-version profile allows R5 DiagnosticReport content to be represented via FHIR STU3 DiagnosticReport resources.
A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
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.
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.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL NOT contain any narrative
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
Observation[classCode=OBS, moodCode=EVN]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource, and may 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.
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 in formation is added later.
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.
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.
R5: `DiagnosticReport.resultsInterpreter` (new:Reference(Practitioner,PractitionerRole,Organization,CareTeam))
Element `DiagnosticReport.resultsInterpreter` has a context of DiagnosticReport based on following the parent source element upwards and mapping to `DiagnosticReport`. Element `DiagnosticReport.resultsInterpreter` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Might not be the same entity that takes responsibility for the clinical report.
All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
R5: Comments about the diagnostic report (new)
R5: `DiagnosticReport.note` (new:Annotation)
Element `DiagnosticReport.note` has a context of DiagnosticReport based on following the parent source element upwards and mapping to `DiagnosticReport`. Element `DiagnosticReport.note` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). May include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.
R5: Reference to full details of an analysis associated with the diagnostic report (new)
R5: `DiagnosticReport.study` (new:Reference(GenomicStudy,ImagingStudy))
Element `DiagnosticReport.study` has a context of DiagnosticReport based on following the parent source element upwards and mapping to `DiagnosticReport`. Element `DiagnosticReport.study` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). For laboratory-type studies like GenomeStudy, type resources will be used for tracking additional metadata and workflow aspects of complex studies. ImagingStudy and the media element are somewhat overlapping - typically, the list of image references in the media 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.
R5: Additional information supporting the diagnostic report (new)
R5: `DiagnosticReport.supportingInfo` (new:BackboneElement)
Element `DiagnosticReport.supportingInfo` has a context of DiagnosticReport based on following the parent source element upwards and mapping to `DiagnosticReport`. Element `DiagnosticReport.supportingInfo` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
R5: Reference to a Composition resource for the DiagnosticReport structure (new)
R5: `DiagnosticReport.composition` (new:Reference(Composition))
Element `DiagnosticReport.composition` has a context of DiagnosticReport based on following the parent source element upwards and mapping to `DiagnosticReport`. Element `DiagnosticReport.composition` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). The Composition provides structure to the content of the DiagnosticReport (and only contains contents referenced in the DiagnosticReport) - e.g., to order the sections of an anatomic pathology structured report.
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. Usually modifier elements provide negation or qualification. In order 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.
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.
Identifiers assigned to this report by the performer or other systems.
Usually assigned by the Information System of the diagnostic service provider (filler id).
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.
Details concerning a test or procedure requested.
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.
This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Element `DiagnosticReport.basedOn` is mapped to FHIR STU3 element `DiagnosticReport.basedOn` as `SourceIsBroaderThanTarget`. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `DiagnosticReport.basedOn` with unmapped reference targets: CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest. 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.
Literal reference, Relative, internal or absolute URL
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.
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.
Logical reference, when literal reference is not known
An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.
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. When 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 Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
Plain text narrative that identifies the resource in addition to the resource reference.
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.
registered | partial | preliminary | final +
The status of the diagnostic report as a whole.
This is labeled as "Is Modifier" because applications need to take appropriate action if a report is withdrawn.
Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.
statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"
unique id for the element within a resource (for internal references)
R5: registered | partial | preliminary | modified | final | amended | corrected | appended | cancelled | entered-in-error | unknown additional codes
R5: `DiagnosticReport.status` additional codes
Element `DiagnosticReport.status` is mapped to FHIR STU3 element `DiagnosticReport.status` as `RelatedTo`. The mappings for `DiagnosticReport.status` do not allow expression of the necessary codes, per the bindings on the source and target. The target context `DiagnosticReport.status` is a modifier element, so this extension does not need to be defined as a modifier.
A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.
inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
A code or name that describes this diagnostic report.
OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)
The subject of the report - usually, but not always, the patient
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.
PID-3 (no HL7 v2 mapping for Group or Device)
Element `DiagnosticReport.subject` is mapped to FHIR STU3 element `DiagnosticReport.subject` as `SourceIsBroaderThanTarget`. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `DiagnosticReport.subject` with unmapped reference targets: BiologicallyDerivedProduct, Device, Group, Location, Medication, Organization, Patient, Practitioner, Substance.
The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport per is about.
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 or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests).
Links the request to the Encounter context.
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
R5: `DiagnosticReport.encounter` additional types from child elements (display, identifier, reference, type)
Element `DiagnosticReport.encounter` is mapped to FHIR STU3 element `DiagnosticReport.context` as `SourceIsBroaderThanTarget`. The mappings for `DiagnosticReport.encounter` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `DiagnosticReport.encounter` with unmapped reference targets: Encounter. 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).
Clinically relevant time/time-period for report
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.
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.
Need to know where in the patient history to file/present this report.
The date and time that this version of the report was released from the source diagnostic service.
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.
Clinicians need to be able to check the date that the report was released.
Indicates who or what participated in producing the report.
PRT-8 (where this PRT-4-Participation = "PO")
Additional Content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. In order 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.
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 that contains it. Usually modifier elements provide negation or qualification. In order 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.
Describes the type of participation (e.g. a responsible party, author, or verifier).
Indicate a role of diagnostic report performer
Practitioner or Organization participant
The reference to the practitioner or organization involved in producing the report. For example, the diagnostic service that is responsible for issuing the report.
This is not necessarily the source of the atomic data items. It is the entity that takes responsibility for the clinical report.
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.
Details about the specimens on which this diagnostic report is based.
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.
Need to be able to report information about the collected specimens on which the report is based.
R5: `DiagnosticReport.specimen` additional types from child elements (display, identifier, reference, type)
Element `DiagnosticReport.specimen` is mapped to FHIR STU3 element `DiagnosticReport.specimen` as `SourceIsBroaderThanTarget`. The mappings for `DiagnosticReport.specimen` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `DiagnosticReport.specimen` with unmapped reference targets: Specimen. 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.
Observations - simple, or complex nested groups
Observations that are part of this diagnostic report. Observations can be simple name/value pairs (e.g. "atomic" results), or they can be grouping observations that include references to other members of the group (e.g. "panels").
Need to support individual results, or report groups of results, where the result grouping is arbitrary, but meaningful. This structure is recursive - observations can contain observations.
R5: `DiagnosticReport.result` additional types from child elements (display, identifier, reference, type)
Element `DiagnosticReport.result` is mapped to FHIR STU3 element `DiagnosticReport.result` as `SourceIsBroaderThanTarget`. The mappings for `DiagnosticReport.result` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `DiagnosticReport.result` with unmapped reference targets: Observation. Observations can contain observations.
Reference to full details of imaging associated with the diagnostic report
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.
ImagingStudy and ImageManifest 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.
outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]
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).
Many diagnostic services include images in the report as part of their service.
Comment about the image (e.g. explanation)
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.
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.
The provider of the report should make a comment about each image included in the report.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
R5: Reference to the image or data source additional types
R5: `DiagnosticReport.media.link` additional types from child elements (display, identifier, reference, type)
Element `DiagnosticReport.media.link` is mapped to FHIR STU3 element `DiagnosticReport.image.link` as `SourceIsBroaderThanTarget`. The mappings for `DiagnosticReport.media.link` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `DiagnosticReport.media.link` with unmapped reference targets: DocumentReference.
Concise and clinically contextualized impression / summary of the diagnostic report.
Need to be able to provide a conclusion that is not lost among the basic result data.
inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
Diagnosis codes provided as adjuncts to the report.
inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.
"application/pdf" is recommended as the most reliable and interoperable in this context.
Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.