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Rodolfo Melia

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FHIR resource link

https://build.fhir.org/diagnosticreport.html

http://hl7.org/fhir/diagnosticreport.html

https://hl7.org/fhir/R4B/diagnosticreport.html

FHIR definition

(v5.0)

The findings and interpretation of diagnostic tests performed on patients, groups of patients, products, substances, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports. The report also includes non-clinical context such as batch analysis and stability reporting of products and substances.

PSI use case

Findings and interpretation of diagnostic tests performed on patients, groups of patients. The report includes context such a

  1. subject: for whom was the test performed

  2. requestor (who ordered the test, if applicable)

  3. performer - who did the test

  4. interpreter/reporter - who provided the test result information

FHIR required properties

see below

PSI required properties*

Country and PsiProjectCode *

+text

Extensions

future use

Sample payload

(minimum set)

Code Block
languagejson
{
  "resourceType": "DiagnosticReport",
  "id": "diagnosticreport-example",
  "status": "final",
  "code": {
    "coding": [
      {
        "system": "http://loinc.org",
        "code": "16581-5",
        "display": "HIV 1+2 Ab [Presence] in Serum"
      }
    ],
    "text": "HIV 1+2 Ab [Presence] in Serum"
  },
  "subject": {
    "reference": "Patient/example"
  },
  "effectiveDateTime": "2013-01-17T08:00:00+00:00",
  "issued": "2013-01-20T08:00:00+00:00",
  "performer": [
    {
      "reference": "Practitioner/example"
    }
  ],
  "resultsInterpreter": [
    {
      "reference": "#p1"
    }
  ],
  "specimen": [
    {
      "reference": "#s1"
    }
  ],
  "result": [
    {
      "reference": "#r1"
    }
  ],
  ...
}

Notes for Diagnosis Report FHIR resource, per property

Property

Required by PSI?

Notes

PSI tags

Status
colourGreen
titleYes
[psi/fhir]

Country ISO-3 code

/wiki/spaces/DHM/pages/13992045

PENDING: implementation as extension

basedOn

Status
colourYellow
titleoptional
[psi/fhir]

Service Request (could be a voucher)
CarePlan

status

Status
colourGreen
titleYes
[psi/fhir]

for R4B:
registered: report exist, but it is not yet logged
preliminary: initial or interim observation: data may be incomplete or unverified
modified: Not yet final, the resource has been updated
final: complete and verified by an authorized person
amended: modified after being marked as final
corrected: an error has been rectified
cancelled: started, but not completed
entered-in-error | unknown

only for R5:
partial: aka draft - data is incomplete or unverified
amended: after final, data has been added (but not modified)

category

Status
colourGreen
titleYes
[psi]

Service category. Examples:
IMM - Immunology

code

Status
colourGreen
titleYes
[psi/fhir]

LOINC code. Example:

Code Block
"http://loinc.org",
"code": "16581-5",
"display": "HIV 1+2 Ab [Presence] in Serum"

List of LOINC codes for HIV Testing 75622-1

subject

Status
colourGreen
titleYes
[psi]

The patient ID that this result relates to.

encounter

Status
colourYellow
titleoptional
[psi]

The encounter ID that triggered this diagnosis

performer

Status
colourGreen
titleYes
[psi]

Who did the test
Expected: Organization id, Practitioner id

Status
colourRed
titlelimitation
: will not take Patient id.
Self Testing: we will store a null value (Aug 2023).
(seeking feedback from community about how best to report self-testing)

resultsInterpreter

Status
colourGreen
titleYes
[psi]

Who interpreted the results
Expected: Organization id, Practitioner id

Status
colourRed
titlelimitation
: will not take Patient id.
Self Testing: we will store a null value (Aug 2023).
(seeking feedback from community about how best to report self-testing)

specimen

Status
colourYellow
titleoptional
[psi/fhir]

Sample ID, if applicable

result

Status
colourGreen
titleYes
[psi]

Although optional in FHIR, at PSI if we create a Diagnosis Report is because we have a result to store.

Based on SNOMED CT Clinical findings. Examples

Status
colourYellow
titleneed verification

  • HIV positive: 165816005
    ICD-10 Codes: Z21X

  • HIV negative: 165815009
    ICD-10 Codes: No Cross-Mapping.

  • HIV 1 indeterminate: 719727000
    ICD-10 Codes: No Cross-Mapping

  • HIV 2 indeterminate: 719767004
    ICD-10 Codes: No Cross-Mapping.

Source: Finding of HIV status (snomedbrowser.com)

note

Status
colourYellow
titleoptional
recommended [psi/fhir]

Comments about the diagnostic report
Examples: “Patient self-reported”. “AI image interpretation”

media/link

Status
colourYellow
titleoptional
[psi/fhir]

http://hl7.org/fhir/R5/documentreference.html

conclusion

Status
colourYellow
titleoptional
[psi/fhir]

markdown, free text

conclusionCode

Status
colourYellow
titleoptional
[psi/fhir]

SNOMED CT code, if result is conclusive

...