MedMij:V2017.04 FHIR LaboratoryResults
{{#customtitle:MedMij FHIR use case LaboratoryResults}}
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Introduction
Actors involved
| Persons | Systems | FHIR Capability Statements | |||
|---|---|---|---|---|---|
| Name | Description | Name | Description | Name | Description |
| Patient | The user of a personal healthcare enviorment. | PHR | Personal health record |  CapabilityStatement: Client
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LaboratoryResults process client requirements |
| Healthcare professional | The user of a XIS | XIS | Healthcare information system | CapabilityStatement: Server
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LaboratoryResults server requirements |
Use case: retrieve laboratory results
Introduction
The retrieve laboratory results transaction is used by the PHR to retrieve a laboratory results from a XIS.
Actors
| Transaction group | Transaction | Actor | Role |
|---|---|---|---|
| Retrieve Laboratory Results(PULL) | Retrieve laboratory results request | Patient (using a PHR) | Request laboratory results from the XIS |
| Retrieve laboratory results response | Healthcare professional (using a XIS) | Serves laboratory results to the PHR |
Invocations
PHR: request message
The request message represents an HTTP GET parameterized query from the PHR to the XIS.
Trigger Events
When the patient(PHR) wants to obtain laboratory results, it issues a retrieve laboratory results request message.
Message Semantics
The PHR executes an HTTP GET conform to the FHIR RESTfull and search specification against the XIS's Observation endpoint. This search query URL is configurable by the PHE and has the following format.
GET [base]/Observation?[parameters]{&_format=[mime-type]}
Search Parameters
The PHR may supply, and the XIS shall be capable of processing, all query parameters listed below. These search parameters are a selection of the defined search parameters by the HL7 FHIR specification search parameters of Observation.
| Observation | ||
|---|---|---|
| Name | Type | Description |
| date | date | Obtained date/time. If the obtained element is a period, a date that falls in the period. |
| category | token | The classification of the type of observation. |
Search on fixed category code
To distinguish the ZIB LaboratoryTestResults Observations between other Observation resources, such as ZIB DrugUse observations, a fixed category code has been added to the ZIB LaboratoryTestResults profile. This fixed category code is solely used for indexing and retrieval of the ZIB building blocks. For LaboratoryTestResult Observations this category is SNOMED code '118246004' - Laboratory test finding (navigational concept).
Including other resources in search results
The PHR may request that the XIS return resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources. This is useful when the PHR is searching on a clinical resource, but for every such resource returned, the client will also need for example the subject (Patient resource) or performer (Organization / Practitioner resource) or Specimen resource that the clinical resource refers to. The client can use the _include parameter to indicate that the subject resources be included in the results. An example are shown below.
Example search URLs
1. GET https://vonk.test-nictiz.nl/Observation?category=http://snomed.info/sct|118246004 2. GET https://vonk.test-nictiz.nl/Observation?category=http://snomed.info/sct|118246004&date=ge2010-01-01 3. GET https://vonk.test-nictiz.nl/Observation?category=http://snomed.info/sct|118246004&date=ge2010-01-01&date=le2011-12-31 4. GET https://vonk.test-nictiz.nl/Observation?include=Observation:specimen&category=http://snomed.info/sct|118246004date=ge2010-01-01&date=le2011-12-31
- Retrieves all ZIB LaboratoryTestResults Observation resources
- Retrieves all ZIB LaboratoryTestResults Observation resources that have an effective date greater than 01-01-2010.
- Retrieves all ZIB LaboratoryTestResults Observation resources that have an effective date within a 2 year period.
- Retrieves all ZIB LaboratoryTestResults Observation resources that have an effective date within a 2 year period and includes Specimen information in the searchresults.
Expected Actions
The XIS shall process the query to discover Observation resources that match the search parameters given.
XIS: response message
The XIS returns a HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching observation information.
Trigger Events
The XIS completed processing of the retrieve laboratory results request message.
Message Semantics
Based on the query results, the XIS will either return an error or success. When the XIS needs to report an error, it SHALL use HTTP error response codes and SHOULD include a FHIR OperationOutcome resource with more details on the failure. If the request message is processed successfully, whether or not any observation resources are found, the HTTP status code SHALL be 200.
The response message shall be a Bundle resource of type "searchset" containing zero or more FHIR resources as entries. If the XIS is sending warnings, the Bundle resource SHALL also contain a FHIR OperationOutcome resource that contains those warnings. The FHIR specification describes the relevant sections:
Message resource content
The returned data to the PHR should conform to the profiles listed in the table below. This table shows the relevant ZIBs and their related profiles. The resources in the response message SHALL be a valid instance of these profiles. All resources SHALL include their related profile canonical URL in the meta.profile element in order to show compliance.
| ZIB name NL | ZIB name EN | FHIR Resource | URL profile | Reference to section |
| Patient | Patient | Patient | http://fhir.nl/fhir/StructureDefinition/nl-core-patient | Patient
|
| Zorgverlener | HealthProfessional | Practitioner | http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner | HealthProfessional
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| Zorgaanbieder | HealthcareProvider | Organization | http://fhir.nl/fhir/StructureDefinition/nl-core-organization | HealthcareProvider
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| LaboratoriumUitslag | LaboratoryTestResult | Observation | http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation | LaboratoryTestResult
|
| Specimen | http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Specimen |
Expected Actions
The PHR shall process the results according to application-defined rules. The PHR should be robust as the response may contain observation and specimen resources that match the query parameters.
Interactions, operations, search parameters
Interactions
The following logical interactions are needed for the retrieve laboratory results transaction:
Operations
No operations are defined or needed for this transaction.
Search parameters
The following search parameter type needs to be supported for this transaction.
Search parameter types:
Search result parameters:
Examples
Use case: retrieve laboratory diagnostic report
Introduction
The retrieve laboratory diagnostic report transaction is used by the PHR to retrieve a laboratory results from a XIS.
Actors
| Transaction group | Transaction | Actor | Role |
|---|---|---|---|
| Retrieve Laboratory Results(PULL) | Retrieve laboratory diagnostic report request | Patient (using a PHR) | Request laboratory diagnostic report from the XIS |
| Retrieve laboratory diagnostic report response | Healthcare professional (using a XIS) | Serves laboratory diagnostic report to the PHR |
Invocations
PHR: request message
The request message represents an HTTP GET parameterized query from the PHR to the XIS.
Trigger Events
When the patient(PHR) wants to obtain laboratory diagnostic report information, it issues a retrieve laboratory diagnostic report request message.
Message Semantics
The PHR executes an HTTP GET conform to the FHIR RESTfull and search specification against the XIS's DiagnosticReport endpoint. This search query URL is configurable by the PHE and has the following format.
GET [base]/DiagnosticReport?[parameters]{&_format=[mime-type]}
Search Parameters
The PHR may supply, and the XIS shall be capable of processing, all query parameters listed below. These search parameters are a selection of the defined search parameters by the HL7 FHIR specification search parameters of DiagnosticReport.
| DiagnosticReport | ||
|---|---|---|
| Name | Type | Description |
| date | date | The clinically relevant time of the report. |
| category | token | Which diagnostic discipline/department created the report. |
Search on ZIB LaboratoryTestResult DiagnosticReport
A fixed category code has been added to the ZIB LaboratoryTestResults profile to distinguish the ZIB LaboratoryTestResult DiagnosticReports between other DiagnosticReport resources. This fixed category code is solely used for indexing and retrieval of the ZIB building blocks. For LaboratoryTestResult DiagnosticReport this category is SNOMED code '4241000179101' - Laboratory report (record artifact).
Including other resources in searchresults
The PHR may request that the XIS return resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources. This is useful when the PHR is searching on a clinical resource, but for every such resource returned, the client will also need for example the subject (Patient resource) or performer (Organization / Practitioner resource) or the Observastion resource that the clinical resource refers to. The client can use the _include parameter to indicate that the subject resources be included in the results. An example are shown below.
Example search URLs
1. GET https://vonk.test-nictiz.nl/DiagnosticReport?category=http://snomed.info/sct|4241000179101 2. GET https://vonk.test-nictiz.nl/DiagnosticReport?category=http://snomed.info/sct|4241000179101&date=ge2010-01-01 3. GET https://vonk.test-nictiz.nl/DiagnosticReport?category=http://snomed.info/sct|4241000179101&date=ge2010-01-01&date=le2011-12-31 4. GET https://vonk.test-nictiz.nl/DiagnosticReport?category=http://snomed.info/sct|4241000179101&include=DiagnosticReport:result&date=ge2010-01-01&date=le2011-12-31
- Retrieves all ZIB LaboratoryTestResult DiagnosticReport resources
- Retrieves all ZIB LaboratoryTestResult DiagnosticReport resources that have an effective date greater than 01-01-2010.
- Retrieves all ZIB LaboratoryTestResult DiagnosticReport resources that have an effective date within a 2 year period.
- Retrieves all ZIB LaboratoryTestResult DiagnosticReport resources that have an effective date within a 2 year period and include the referenced Observation resources in the searchresults.
Expected Actions
The XIS shall process the query to discover DiagnosticReport resources that match the search parameters given.
XIS: response message
The XIS returns a HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching laboratory diagnostic report information.
Trigger Events
The XIS completed processing of the retrieve laboratory diagnostic report request message.
Message Semantics
Based on the query results, the XIS will either return an error or success. When the XIS needs to report an error, it SHALL use HTTP error response codes and SHOULD include a FHIR OperationOutcome resource with more details on the failure. If the request message is processed successfully, whether or not any DiagnosticReport resources are found, the HTTP status code SHALL be 200.
The response message shall be a Bundle resource of type "searchset" containing zero or more FHIR resources as entries. If the XIS is sending warnings, the Bundle resource SHALL also contain a FHIR OperationOutcome resource that contains those warnings. The FHIR specification describes the relevant sections:
Message resource content
The returned data to the PHR should conform to the profiles listed in the table below. This table shows the relevant ZIBs and their related profiles. The resources in the response message SHALL be a valid instance of these profiles. All resources SHALL include their related profile canonical URL in the meta.profile element in order to show compliance.
| ZIB name NL | ZIB name EN | FHIR Resource | URL profile | Reference to section |
| Patient | Patient | Patient | http://fhir.nl/fhir/StructureDefinition/nl-core-patient | Patient
|
| Zorgverlener | HealthProfessional | Practitioner | http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner | HealthProfessional
|
| Zorgaanbieder | HealthcareProvider | Organization | http://fhir.nl/fhir/StructureDefinition/nl-core-organization | HealthcareProvider
|
| LaboratoriumUitslag | LaboratoryTestResult | DiagnosticReport | http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-DiagnosticReport | LaboratoryTestResult
|
| Observation | http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation | |||
| Specimen | http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Specimen |
Expected Actions
The PHR shall process the results according to application-defined rules. The PHR should be robust as the response may contain DiagnosticReport, Observation and Specimen resources that match the query parameters.
Interactions, operations, search parameters
Interactions
The following logical interactions are needed for the retrieve laboratory results transaction:
Operations
No operations are defined or needed for this transaction.
Search parameters
The following search parameter type needs to be supported for this transaction.
Search parameter types:
Search result parameters: