2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

U.S. Data Access Framework (DAF) Results Profile (Conformance Package)

Scope and Usage

This profile sets expectations for use of the Observation resource to record lab results associated with a patient within the Data Access Framework (DAF) Implementation Guide. This profile identifies which core elements,extensions,vocabularies and value sets must be supported by DAF actors.

For the purposes of this profile, Supported means the following:

    SearchParameters:

  • DAF Query Requestor (client) SHALL be capable of querying the Observation resource using one or more of the search parameters for data elements tagged as MUST SUPPORT in this profile.
  • DAF Query Responder (server) SHALL be capable of receiving the queries submitted by the DAF Query Requestor and provide Query Results or error responses per the FHIR specifications.
  • DAF Query Responder MAY provide valid or error responses when the query parameters submitted contain data elements which are not tagged as MUST SUPPORT by this profile.

    • Query Results:

  • Query Results returned by DAF Query Responder SHOULD contain the data elements identified as MUST SUPPORT in the profile.
  • Query Results returned MAY contain data elements not tagged as MUST SUPPORT by the this profile.
  • Query Requestor SHALL process the Query Results containing additional data elements without indicating that the response is an erroneous response.

    • Missing Information:

  • When Query Results do not contain a particular data element identified as MUST SUPPORT, Query Requestors SHALL interpret the results to mean that the Query Responder did not have information and there is no further qualifying information as to why the information is missing.
  • In cases, where the Query Responder knows precisely the reason why the data is missing (e.g notasked in the data-absent-reason value set), then Query Responders MAY provide this additional information using the extension element as part of the data element. Query Requestors SHALL correctly process the data-absent-reason extension without rejecting the response as an erroneous response.

Relationship to Meaningful Use

The DAFResults profile provides a mapping for the following Meaningful Use data elements to FHIR data elements.


Meaningful Use Data Element Name FHIR Resource Mapping
Lab Test Name Observation.name.coding.code
Lab Test Result Observation.value[x](Code,Quantity,Ratio or other)
Lab Test Specimen collection date Observation.applies[x]
Lab Test Result Available Date Observation.issued
Lab Test Result Interpretation Observation.interpretation
Lab Test Result Reference Range Observation.referenceRange
Body Site used to collect specimen Observation.bodySite[x]

Boundaries and Relationships

This profile relies on the use of other profiles, some required, others available for use "when necessary":

  • DAFPatient which defines DAF Patient profile used by Observation.subject.
  • FHIR Extensibility defines how extensions can be applied to FHIR resources and data types. Specifically the data-absent-reason extension is used to code data elements with missing information when appropriate.

Profile Details

Profiles:
DAFResultObservationCodeDAF laboratory result (value is code)
DAFResultObsQuantityDAF laboratory result (value is quantity)
DAFResultObsRatioDAF laboratory result (value is ratio)
DAFResultObsOtherDAF laboratory result (value is none of above)

Example Usage Scenarios

The following are example usage scenarios for the DAFResults profile:

  • Query for lab results belonging to a Patient
  • Query for all patients who have had a specific lab test result available
  • Query for lab results based on type of lab test
  • Query for all patients with a lab test (e.g hba1c) beyond the acceptable reference range

Additional Implementation Guidance

Implementers need to be mindful of the following during their implementation

    Using Right DAF Result profile: Implementers are advised to use the right DAFResult profile based on the value to be represented. For example, in case the value element is a codeableConcept implementers should use DAFResultObservationCode profile. Similarly for representing Quantity, Ratio and Other types of results the appropriate DAFResult profile listed above should be used.

    Representing No Known Lab Results: No Known Lab Results will be represented using the DAFResults List with no entries and with an empty reason.

    Specifying Patients as part of the Results Queries: DAFResults profile supports the querying the Observations for a particular patient. In order to achieve this in implementation, it is recommended to use Patient.identifier field to precisely identify the allergies relevant to the patient. While other parameters such as Patient.name, Patient.given could be used for the query, it could lead to incorrect Patient matching and/or inefficient queries when systems are not tuned.

    Patient Matching: Patient Matching rules and criteria have to be evaluated by the implementing organization and have to comply with local policies and regulations. Query Requestors will have to deal with result sets that can return zero,one or more Observation Resources in response to a query.