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Resource LabReport - Content 3.6

Status: Not an approved resource: Exemplar - based on the Australian peEHR model. Comments will be welcomeed by O & O workgroup

The findings and interpretation of pathology tests performed on tissues and body fluids. This is typically done in a laboratory but may be done in other environments such as at the point of care.

The resource name as it appears in a RESTful URL is /labreport/

Resource Content 3.6.1

<LabReport xmlns="http://hl7.org/fhir">
 <status><!-- 1..1 code registered|interim|final|amended|cancelled|withdrawn --></status>
 <issued><!-- 1..1 instant date issed for current status --></issued>
 <patient><!-- 1..1 Resource(Patient) The patient the report is about --></patient>
 <admission><!-- 0..1 Resource(Admission) Admission Context --></admission>
 <laboratory><!-- 1..1 Resource(Organization) Responsible Laboratory --></laboratory>
 <reportId><!-- 0..1 Identifier Id for external references to this report --></reportId>
 <requestDetail>  <!-- 0..* What was requested -->
  <requestOrderId><!-- 0..1 Identifier Id assigned by requester --></requestOrderId>
  <receiverOrderId><!-- 0..1 Identifier Receiver's Id for the request --></receiverOrderId>
  <requestTest><!-- 0..* CodeableConcept Test Requested --></requestTest>
  <requester><!-- 0..1 Resource(Agent|Organization) Responsible for request --></requester>
  <clinicalInfo><!-- 0..1 Resource(Any) Clinical information provided --></clinicalInfo>
 </requestDetail>
 <reportName><!-- 1..1 CodeableConcept Name for the entire report --></reportName>
 <service><!-- 0..1 CodeableConcept Biochemistry, Haematology etc --></service>
 <diagnosticTime><!-- 1..1 dateTime Effective time of diagnostic report --></diagnosticTime>
 <specimen><!-- 0..* Resource(Specimen) Specimen (incl. time of collection) --></specimen>
 <resultGroup>  <!-- 0..* Results grouped by specimen/kind/category -->
  <name><!-- 0..1 CodeableConcept What defines the group --></name>
  <specimen><!-- 0..1 Resource(Specimen) Specimen details --></specimen>
  <result>  <!-- 1..* A particular result -->
   <name><!-- 0..1 CodeableConcept Name or code of the result --></name>
   <value[x]><!-- 0..1 Quantity|CodeableConcept|Attachment|
              Ratio|Choice|Period|string Result. [x] = type name --></value[x]>
   <flag><!-- 0..1 code + | ++ | +++ | - | -- | ---  --></flag>
   <status><!-- 1..1 code Registered|Interim|Final|Amended|Cancelled|Withdrawn --></status>
   <comments><!-- 0..1 string Comments about result --></comments>
   <referenceRange>  <!-- 0..* Guide for interpretation -->
    <meaning><!-- 0..1 CodeableConcept The meaning of this range --></meaning>
    <range[x]><!-- 1..1 Quantity|Range|string Reference --></range[x]>
   </referenceRange>
  </result>
 </resultGroup>
 <conclusion><!-- 0..1 string Clinical Interpretation of test results --></conclusion>
 <codedDiagnosis><!-- 0..* CodeableConcept Codes for the conclusion --></codedDiagnosis>
 <representation><!-- 0..* Attachment Entire Report as issued --></representation>
 <extension><!-- 0..* Extension  See Extensions  --></extension>
 <text><!-- 1..1 Narrative Text summary of resource (for human interpretation) --></text>
</LabReport>

Alternate definitions: Schema/Schematron, RDF (to do), XML, XMI (to do), Resource Profile

Terminology Bindings

Path	Details	Strength
LabReport.status LabReport.resultGroup.result.status	The status of a report or result item (see http://hl7.org/fhir/lab-report-status for values)	complete/required
LabReport.requestDetail.requestTest	codes for requestable tests (not bound to any particular codes)	complete/unstated
LabReport.reportName	LOINC Panel Names	complete/preferred
LabReport.service	HL7 v2 table 0074	complete/preferred
LabReport.resultGroup.name	LOINC Panel Names	complete/preferred
LabReport.resultGroup.result.name	LOINC Result names	complete/preferred
LabReport.resultGroup.result.flag	codes for result flags (see http://hl7.org/fhir/lab-result-flag for values)	complete/required
LabReport.resultGroup.result.referenceRange.meaning	Code for the meaning of a reference range (not bound to any particular codes)	complete/unstated
LabReport.codedDiagnosis	SNOMED-CT Diagnoses	complete/suggested

Notes: 3.6.2

• About naming: a laboratory produces "reports" that is a collection of "tests" that produce "results". Clinical consumers call the whole collection "the results". There is much potential confusion around these names. The confusion is worsened because "the report" is sometimes a document which entirely contains narrative, sometimes it is purely atomic data results, and sometimes it's a mix of both.
• The scope of this resource is the laboratory reporting process. While this resource includes some elements that relate to the ordering cycle, these are only included to the degree that it is useful for the final report to refer back to the orders. Different resources are required for supporting the ordering cycle.
• This laboratory report model provides a 3 level structure for the results - a report contains a list of groups, each of which contains a list of results. Results are grouped by either a specimen or a code that indicates that nature of the grouping (e.g. organism isolate/sensitivity or antibody functional testing). While many common lab reports don't need or benefit directly from the group structure, this lab report model imposes the group structure anyway. This means that these lab reports have a single group which has no code on it, and which contains all the results. The advantage of this model is that all the results are found at the same point in the hierarchy, and there is a single point on the hierarchy - the group - that may influence the meaning of the test.
• The element that contains the actual value of the result has a variable name depending on the type. The name is "value" + the type name, ignoring parameters, with a capital on the first letter, e.g. valueInterval or valueString
• The clinical information associated with a request can be a simple text summary, or a reference to another resource
• The diagnosticTime can be inferred from the specimens, if they are provided, but specimen details are often not provided, and the value of diagnosticTime is always important. The value of the diagnosticTime element must be consistent with the specimen collection times
• Applications consuming lab reports must take careful note of updates to lab reports, and particularly note withdrawn reports. A report shouldn't be final until all the results are final or amended. If a report is withdrawn, all the results must be withdrawn by replacing every result value with the Concept "withdrawn" in the internal terminology "Special values" (sid = "http://hl7.org/fhir/sid/fhir/special-values"), and setting the conclusion (if provided) and the text narrative to some text like "This report has been withdrawn". A reason may be provided in the narrative.

Relationship between results, narrative, and synoptic reports 3.6.2.1

One difficult aspect of the design of this resource can be captured with a simple question: "just what is a result?" There is a wide range of variation in the answers to this question; some respond that a result is inherently measurement based, while others focus on the clinical utility of the data item.

Some practical examples:

• Tumor dimensions in synoptic reports
• Injection volumes in radiology reports
• Phenotypes and genotypes in pathology reports
• Images (Scatter plots, electrophoresis photos, slide photos, chromatograms)

Which of these are results? For this resource, we have chosen to take an inclusive view; any of these things can be a result, as long as they have a formal code or name that has a clinical meaning, and some kind of (possible) value then they can be a result.

Search Parameters 3.6.3

Search Parameters for RESTful searches. The standard parameters also apply. See Searching for more information.

$page : integer	Starting offset of the first record to return in the search set	single
$count : integer	Number of return records requested. The server is not bound to conform	single
$id : token	The logical resource id associated with the resource (must be supported by all servers)	single
test : qtoken	the name or code of either a requested test, the report or a report group	union
result : qtoken	the name or code of a result or result group	union
specimen : qtoken	Either of the specimens	union
patient : qtoken	The identity of a patient	union
laboratory : qtoken	The identity of an laboratory	union
status : token	The status of the lab report	union
request : qtoken	A test requested	union
diagnosis : qtoken	code of a diagnosis	union

(See Searching).

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Implementers are welcome to experiment with the content defined here, but should note that the contents are subject to change without prior notice.
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