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4.17 Resource DiagnosticOrder - Content

A request for a diagnostic investigation service to be performed.

4.17.1 Scope and Usage

A Diagnostic Order is a record of a request for a set of diagnostic investigations to be performed. The investigation will lead to a Diagnostic Report that summarizes the outcome of the investigation, and includes any useful data and/or images that are relevant to the treatment/management of the subject.

The principal intention of the Diagnostic Order is to support ordering diagnostic investigations on patients (which includes non-human patients in veterinary medicine). However in many contexts, healthcare related processes include performing diagnostic investigations on groups of subjects, devices involved in the provision of healthcare, and even environmental locations such as ducts, bodies of water, etc. The Diagnostic Order supports all these usages.

The general work flow that this resource facilitates is that a clinical system creates a diagnostic order. The diagnostic order is then exchanged, perhaps via intermediaries, with a system that represents a diagnostic service that can perform the investigation as a request to do so. The diagnostic service will update the request as the work is performed, and then finally issue a report that references the requests that it fulfills.

4.17.2 Boundaries and Relationships

Note that the Diagnostic Order itself is not a request to perform the investigation - it is just a record of the fact that a request was made. To actually request that a diagnostic procedure be performed, additional workflow beyond sumply the existence of a Diagnostic Order is required. This can be achieved by using an Order resource, with the Diagnostic Order referenced from the Order.details, or by using the Diagnostic Order resource in the context of of an messaging or service workflow where the request is explicit or implicit.

4.17.3 Resource Content

DiagnosticOrder (Resource)Who or what the investigation is to be performed on. This is usually a human patient, but diagnostic tests can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans)subject : Resource(Patient|Group|Location|Device) 1..1The practitioner that holds legal responsibility for ordering the investigationorderer : Resource(Practitioner) 0..1Identifiers assigned to this order by the order or by the receiveridentifier : Identifier 0..*An encounter that provides additional informaton about the healthcare context in which this request is madeencounter : Resource(Encounter) 0..1An explanation or justification for why this diagnostic investigation is being requestedclinicalNotes : string 0..1One or more specimens that the diagnostic investigation is aboutspecimen : Resource(Specimen) 0..*The status of the orderstatus : code 0..1 <<The status of a diagnostic orderDiagnosticOrderStatus>>The clinical priority associated with this orderpriority : code 0..1 <<The clinical priority of a diagnostic orderDiagnosticOrderPriority>>EventThe status for the eventstatus : code 1..1 <<The status of a diagnostic orderDiagnosticOrderStatus>>Additional information about the event that occurred - e.g. if the status remained unchangeddescription : CodeableConcept 0..1 <<Additional information about an event that occurred to a diagnostic order - e.g. if the status remained unchangedDIagnosticOrderEventDescription>>The date/time at which the event occurreddateTime : dateTime 1..1The person who was responsible for performing or recording the actionactor : Resource(Practitioner|Device) 0..1ItemA code that identifies a particular diagnostic investigation, or panel of investigations, that have been requestedcode : CodeableConcept 1..1 <<Codes for tests/services that can be performed by diagnostic servicesDiagnosticRequests>>If the item is related to a specific specimentspecimen : Resource(Specimen) 0..*Anatomical location where the request test should be performedbodySite : CodeableConcept 0..1 <<Codes describing anatomical locations. May include lateralityBodySite>>The status of this individual item within the orderstatus : code 0..1 <<The status of a diagnostic orderDiagnosticOrderStatus>>A summary of the events of interest that have occurred as the request is processed. E.g. when the order was made, various processing steps (specimens received), when it was completedevent0..*A summary of the events of interest that have occurred as this item of the request is processedevent0..*The specific diagnostic investigations that are requested as part of this request. Sometimes, there can only be one item per request, but in most contexts, more than one investigation can be requesteditem0..*

This resource is referenced by CarePlan, DiagnosticReport and ImagingStudy

<DiagnosticOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: extension, modifierExtension, language, text, and contained -->
 <subject><!-- 1..1 Resource(Patient|Group|Location|Device) Who and/or what test is about --></subject>
 <orderer><!-- 0..1 Resource(Practitioner) Who ordered the test --></orderer>
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <encounter><!-- 0..1 Resource(Encounter) 
     The encounter that this diagnostic order is associated with --></encounter>
 <clinicalNotes value="[string]"/><!-- 0..1 Explanation/Justification for test -->
 <specimen><!-- 0..* Resource(Specimen) If the whole order relates to specific specimens --></specimen>
 <status value="[code]"/><!-- 0..1 requested | received | accepted | in progress | review | completed | suspended | rejected | failed -->
 <priority value="[code]"/><!-- 0..1 routine | urgent | stat | asap -->
 <event>  <!-- 0..* A list of events of interest in the lifecycle -->
  <status value="[code]"/><!-- 1..1 requested | received | accepted | in progress | review | completed | suspended | rejected | failed -->
  <description><!-- 0..1 CodeableConcept More information about the event and it's context --></description>
  <dateTime value="[dateTime]"/><!-- 1..1 The date at which the event happened -->
  <actor><!-- 0..1 Resource(Practitioner|Device) Who recorded or did this --></actor>
 </event>
 <item>  <!-- 0..* The items the orderer requested -->
  <code><!-- 1..1 CodeableConcept Code to indicate the item (test or panel) being ordered --></code>
  <specimen><!-- 0..* Resource(Specimen) If this item relates to specific specimens --></specimen>
  <bodySite><!-- 0..1 CodeableConcept Location of requested test (if applicable) --></bodySite>
  <status value="[code]"/><!-- 0..1 requested | received | accepted | in progress | review | completed | suspended | rejected | failed -->
  <event><!-- 0..* Content as for DiagnosticOrder.event Events specific to this item --></event>
 </item>
</DiagnosticOrder>

Alternate definitions: Schema/Schematron, Resource Profile

4.17.3.1 Terminology Bindings

PathDefinitionTypeReference
DiagnosticOrder.status
DiagnosticOrder.event.status
DiagnosticOrder.item.status 		The status of a diagnostic orderFixedhttp://hl7.org/fhir/diagnostic-order-status
DiagnosticOrder.priority The clinical priority of a diagnostic orderFixedhttp://hl7.org/fhir/diagnostic-order-priority
DiagnosticOrder.event.description Additional information about an event that occurred to a diagnostic order - e.g. if the status remained unchangedExamplehttp://hl7.org/fhir/vs/diagnostic-order-event
DiagnosticOrder.item.code Codes for tests/services that can be performed by diagnostic servicesIncompletehttp://hl7.org/fhir/vs/diagnostic-requests
DiagnosticOrder.item.bodySite Codes describing anatomical locations. May include lateralityExamplehttp://hl7.org/fhir/vs/body-site

4.17.4 Notes:

4.17.5 Search Parameters

Search parameters for this resource. The standard parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
_idtokenThe logical resource id associated with the resource (must be supported by all servers)
_languagetokenThe language of the resource
actorreferenceWho recorded or did thisDiagnosticOrder.event.actor, DiagnosticOrder.item.event.actor
(Device, Practitioner)
bodysitetokenLocation of requested test (if applicable)DiagnosticOrder.item.bodySite
codetokenCode to indicate the item (test or panel) being orderedDiagnosticOrder.item.code
encounterreferenceThe encounter that this diagnostic order is associated withDiagnosticOrder.encounter
(Encounter)
event-datedateThe date at which the event happenedDiagnosticOrder.event.dateTime
event-statustokenrequested | received | accepted | in progress | review | completed | suspended | rejected | failedDiagnosticOrder.event.status
event-status-datecompositeA combination of past-status and date
identifiertokenIdentifiers assigned to this orderDiagnosticOrder.identifier
item-datedateThe date at which the event happenedDiagnosticOrder.item.event.dateTime
item-past-statustokenrequested | received | accepted | in progress | review | completed | suspended | rejected | failedDiagnosticOrder.item.event.status
item-statustokenrequested | received | accepted | in progress | review | completed | suspended | rejected | failedDiagnosticOrder.item.status
item-status-datecompositeA combination of item-past-status and item-date
ordererreferenceWho ordered the testDiagnosticOrder.orderer
(Practitioner)
specimenreferenceIf the whole order relates to specific specimensDiagnosticOrder.specimen, DiagnosticOrder.item.specimen
(Specimen)
statustokenrequested | received | accepted | in progress | review | completed | suspended | rejected | failedDiagnosticOrder.status
subjectreferenceWho and/or what test is aboutDiagnosticOrder.subject
(Device, Location, Patient, Group)
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