Marija Zivlak op 7 jul 2026 om 12:30

2026-07-07T12:30:32Z

Marija Zivlak: Nieuwe pagina aangemaakt met ' {{DISPLAYTITLE: Technical Design Lab2zorg v4.0.0-beta.1}} ''The Information Standard Lab Exchange consists of four different components: Lab2Zor...'

2026-07-07T12:22:21Z

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{{DISPLAYTITLE: Technical Design Lab2zorg v4.0.0-beta.1}}

''The Information Standard Lab Exchange consists of four different components: Lab2Zorg, Lab2Lab, Lab2PublicHealth, and Lab2Patient. These four components were developed independently of each other and are subject to continuous development. This is reflected in the Semantic Versioning (SemVer). Each component undergoes its own development process with its own corresponding numerical publications.''

{{IssueBox| The FHIR resource used for one of the use cases described in this technical design is DiagnosticReport. DiagnosticReport is not the preferred FHIR resource for the information standard Laboratory exchange. However, this resource has been chosen as it contains information about the order data. Optimally, order data could be linked directly to the preferred FHIR resource Observation via basedOn element. This will be updated in a future version.}}

<imagemap>Bestand:functioneel-technisch-banner_00_alle.png|center|240px|alt=Functioneel-Technisch
circle 204 216 215 [[L2z:v4.0.0_ontwerp_lab2zorg|Functional]]
circle 990 216 215 [[L2z:v4.0.0_FHIR_lab2zorg|Technical]]
desc none
</imagemap>

<big>For an overview of all current documentation [[Landingspagina_Labuitwisseling| see information standard lab exchange main page]]</big>

__NUMBEREDHEADINGS__

==Introduction==
[[Bestand:Functioneel-02.png|link=L2z:v4.0.0_ontwerp_lab2zorg|100px|rechts|Functional design|Go to functional design]]

This is the technical design (TO) for the information standard (IS) Lab2zorg. This TO must be used together with the IS functional design, see [[L2z:v4.0.0_ontwerp_lab2zorg| functional design Lab2zorg]]. The data exchange format used in this version is: FHIR R4.

=== Support ===
For questions, feedback, or change requests, please contact our support team at [https://nictiz.atlassian.net/servicedesk/customer/portal/4 Nictiz Servicemanagement].

=== Boundaries ===
This information standard may overlap with other standards related to identification, roles, and geographic classifications, requiring careful alignment to ensure consistency and avoid duplication. For more information, see [[L2z:v4.0.0_ontwerp_lab2zorg| functional design Lab2zorg]].

=== Prerequisite knowledge ===
The following background information is required for understanding this TO:
* The [[L2z:v4.0.0_ontwerp_lab2zorg| functional design Lab2zorg]] accompanying this TO.
* The data exchange format FHIR R4, which you can find here:
** [[FHIR:V1.0 FHIR IG R4|general FHIR R4 Implementation Guide]],
** [[FHIR:V1.0_FHIR_IG_R4#FHIR_Packages|FHIR packages]],
** [[FHIR:V1.0_FHIR_IG_R4#Usage_of_the_.id.2C_.identifier_and_.fullUrl_elements_in_FHIR_instances|usage of the .id, .identifier and .fullUrl]].

== Relationships ==

The diagrams below show the relationships between different FHIR profiles. The arrows indicate an “is referenced in” relationship.

For example, Patient → Laboratory Test means that the Patient is referenced within the Laboratory Test resource.

===Model overview for usecases without the request===

[[Bestand:FHIR-model-overview-L2Z-SLR-BLR.png]]

===Model overview for usecase with the request===

[[Bestand:FHIR-model-overview-L2P-LOA.png]]

==Components==

HL7 FHIR is used to accommodate the Dutch Clinical Information Models (zibs) used in the IS.

=== HL7 FHIR R4 ===
{{NoteBoxNictizR4Package|p1=nictiz.fhir.nl.r4.labexchange|v1=4.0.0-beta.2|p2=nictiz.fhir.nl.r4.nl-core|v2=0.12.0-labtrial.1|p3=nictiz.fhir.nl.r4.zib2020|v3=0.12.0-labtrial.1}}

==== Artifacts ====

The artifacts of the information standard are presented in the following table:
{| style="text-align: left; background-color: white;" cellpadding=5px;

|- style="color: white; background-color: #e7844b;"
! zib
! FHIR resource
! FHIR profile

|- style="background-color: #fcf0e9;"
| HealthcareProvider
| Organization
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.12.0-beta.1|title=nl-core-HealthcareProvider-Organization}}

|- style="background-color: #fcf0e9;"
| rowspan="2" | HealthProfessional
| Practitioner
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.12.0-beta.1|title=nl-core-HealthProfessional-Practitioner}}

|- style="background-color: #fcf0e9;"
| PractitionerRole
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.12.0-beta.1|title=nl-core-HealthProfessional-PractitionerRole}}

|- style="background-color: #fcf0e9;"
| rowspan="3" | LaboratoryTestResult
| Device
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-LaboratoryTestResult.Specimen.Source|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.7.0-beta.1|title=nl-core-LaboratoryTestResult.Specimen.Source}}

|- style="background-color: #fcf0e9;"
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-LaboratoryTestResult|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.12.0-labtrial.1|title=nl-core-LaboratoryTestResult}}

|- style="background-color: #fcf0e9;"
| Specimen
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-LaboratoryTestResult.Specimen|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.12.0-beta.1|title=nl-core-LaboratoryTestResult.Specimen}}

|- style="background-color: #fcf0e9;"
| Patient
| Patient
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.12.0-beta.1|title=nl-core-Patient}}

|- style="background-color: #fcf0e9;"
|
| DiagnosticReport
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/lu-LaboratoryTestResult-DiagnosticReport|nictiz.fhir.nl.r4.labexchange|pkgVersion=4.0.0-beta.2|title=lu-LaboratoryTestResult-DiagnosticReport}}

|- style="background-color: #fcf0e9;"
|
| ServiceRequest
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/lu-OrderData|nictiz.fhir.nl.r4.labexchange|pkgVersion=4.0.0-beta.2|title=lu-OrderData}}
|}

==== Examples of FHIR instances ====
You can find examples of FHIR-instances (filled-in FHIR profiles) in the Nictiz GitHub repository: [https://github.com/Nictiz/HL7-mappings/tree/master/ada_2_fhir-r4/lab/l2z-3.0.0 <nowiki>Lab exchange HL7-mappings repository</nowiki>].

== Transactions ==
=== Health professional orders lab tests and receives results ===
==== Involved actors ====
{| style="text-align: left;" cellpadding=5px;

|- style="color: white; background-color: #e7844b;"
! Transaction group || Transaction || Actor || System role code || FHIR CapabilityStatement

|- style="background-color: #fcf0e9;"
| rowspan="2" | Send laboratory results based on a request
| Send laboratory results based on a request || Client || LAB-LAS || rowspan="2" |{{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/Lab2Healthcare-Results-SendReceive|nictiz.fhir.nl.r4.labexchange|pkgVersion=4.0.0-beta.2|title=Lab2Healthcare_Results_SendReceive}}

|- style="background-color: #fcf0e9;"
| Receive laboratory results || Server || LAB-LAO

|+ style="align: bottom; caption-side: bottom; text-align: left;" | ''Abbreviations: LAB = Laboratorium, LAS = Laboratoriumresultaat antwoord sturend (systeem), LAO = Laboratoriumresultaat antwoord ontvangend (systeem).''
|}

=== Health professional retrieves lab results ===
==== Involved actors ====
{| style="text-align: left;" cellpadding=5px;

|- style="color: white; background-color: #e7844b;"
! Transaction group || Transaction || Actor || System role code || FHIR CapabilityStatement

|- style="background-color: #fcf0e9;"
| rowspan="2" | Retrieve laboratory results (PULL)
| Retrieve laboratory results request || Client || LAB-LRR || rowspan="2" |{{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/Lab2Healthcare-Results-RetrieveServe|nictiz.fhir.nl.r4.labexchange|pkgVersion=4.0.0-beta.2|title=Lab2Healthcare_Results_RetrieveServe}}

|- style="background-color: #fcf0e9;"
| Retrieve laboratory results response || Server || LAB-LRB

|+ style="align: bottom; caption-side: bottom; text-align: left;" | ''Abbreviations: LAB = Laboratorium, LRR = Laboratoriumresultaat raadplegend (systeem), LRB = Laboratoriumresultaat beschikbaarstellend (systeem).''
|}

==== FHIR Search parameters ====
The search interaction is performed by an HTTP GET in agreement with the [http://hl7.org/fhir/R4/search.html FHIR specification].

Unless stated otherwise, all (repetitions of) parameters and their values SHALL be supported by servers. Parameters with minimum of 1 or up SHALL be supported by clients.

# = number of occurrences of the parameter. Results shall match all occurrences
Value # = number of value occurrences per occurrence of the parameter. Results shall match at least of the value occurrences

Example: {{fhir|1=/Patient?language=FR,NL&language=EN}} would refer to any patient who speaks English, as well as either French or Dutch. language may thus repeat, and may have more than one value.

The table below lists search parameters for Observation resource.

{| style="text-align: left; width: 100%" cellpadding=5px;
|- style="color: white; background-color: #e7844b;"
! Name || # || Value # || Type || Description

|- style="background-color: #fcf0e9;"
| {{fhir|category}} || 1..1 || 1..1 || token || Search for laboratory observation. Fixed value: {{fhir|<nowiki>https://terminology.hl7.org/CodeSystem/observation-category|laboratory</nowiki>}}

|- style="background-color: #fcf0e9;"
| {{fhir|patient}} || 0..1 || 1..1 || token || Limit results to this patient based on their national identifier as burgerservicenummer (BSN). Note that this parameter may be replaced with a different mechanism like an OAuth token, which is why this parameter is not required. {{fhir|<nowiki>http://fhir.nl/fhir/NamingSystem/bsn|[BSN]</nowiki>}}

|- style="background-color: #fcf0e9;"
| {{fhir|code}} || 0..* || 1..* || token || Limit results to observations containing a LOINC or an NHG test code. {{fhir|<nowiki>http://loinc.org|[test code]</nowiki>}}, {{fhir|<nowiki>https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|[test code]</nowiki>}}

|- style="background-color: #fcf0e9;"
| {{fhir|date}} || 0..2 || 1..1 || date || Search on observation date earlier or later than the value. To be used with prefixes {{fhir|lt}} or {{fhir|gt}}.

|- style="background-color: #fcf0e9;"
| {{fhir|_include}} || 0..* || 1..1 || reference || Include linked resource, can be used in conjunction with modifier {{fhir|iterate}} which includes resources iteratively.

|+ style="align: bottom; caption-side: bottom; text-align: left;" |
|}

==== FHIR Operations ====

Clients may invoke {{fhir|$lastn}} to retrieve the most recent Observation(s). The parameter {{fhir|max}} can optionally be provided to specify the number of observations to be returned. For more information on {{fhir|$lastn}}, consult [https://build.fhir.org/observation-operation-lastn.html $lastn operation].

==== FHIR Search examples ====

{| style="text-align: left; width: 100%;" cellpadding=5px;
|- style="color: white; background-color: #e7844b;"
! Examples

|- style="color: white; background-color: #eda778;"
! Show all laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333

|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
| <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7</pre>

|- style="color: white; background-color: #eda778;"
! Show all laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333 from 12 March 2022

|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
| <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7&date=gt2022-12-03</pre>

|- style="color: white; background-color: #eda778;"
! Show all laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333 between 12 March 2022 and 7 June 2022

|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
| <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7&date=gt2022-12-03&date=lt2022-07-06</pre>

|- style="color: white; background-color: #eda778;"
! Show all laboratory results with test code 14683-7 (LOINC) or 3583 (NHG) of the patient with BSN 111222333

|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
| <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7,https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|3583</pre>

|- style="color: white; background-color: #eda778;"
! Show the most recent laboratory result with test code 14683-7 (LOINC) of the patient with BSN 111222333

|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
| <pre>GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7</pre>

|- style="color: white; background-color: #eda778;"
! Show the five most recent laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333

|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
| <pre>GET [base]/Observation/$lastn?max=5&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7</pre>

|- style="color: white; background-color: #eda778;"
! Show the most recent laboratory result of the patient with BSN 111222333

|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
| <pre>GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333</pre>

|+ style="align: bottom; caption-side: bottom; text-align: left;" |
|}

=== Health professional sends lab results to other health professional ===
==== Involved actors ====
{| style="text-align: left;" cellpadding=5px;

|- style="color: white; background-color: #e7844b;"
! Transaction group || Transaction || Actor || System role code || FHIR CapabilityStatement

|- style="background-color: #fcf0e9;"
| rowspan="2" | Send laboratory results (PUSH)
| Send laboratory results || Client || LAB-LRS || rowspan="2" |{{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/Lab2Healthcare-Results-SendReceive|nictiz.fhir.nl.r4.labexchange|pkgVersion=4.0.0-beta.2|title=Lab2Healthcare_Results_SendReceive}}

|- style="background-color: #fcf0e9;"
| Receive laboratory results || Server || LAB-LRO

|+ style="align: bottom; caption-side: bottom; text-align: left;" | ''Abbreviations: LAB = Laboratorium, LRS = Laboratoriumresultaat sturend (systeem), LRO = Laboratoriumresultaat ontvangend (systeem).''
|}

== Additional guidance ==

=== Translations ===

When multiple codings are used for the same laboratory test, they should be represented as translations of the same concept within one {{fhir|CodeableConcept}} ([https://hl7.org/fhir/R4/datatypes.html#CodeableConcept FHIR specification]). This means that the codes do not represent different test results. Instead, they are alternative codes for the same laboratory test.

{{fhir|Observation.code}} may contain multiple {{fhir|coding}} elements:

<pre>
Observation.code
coding[0]: LOINC code
coding[1]: NHG-45 code
coding[2]: internal laboratory code
</pre>

The following code systems may be used:

* {{fhir|http://loinc.org}} for LOINC codes
* {{fhir|https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen}} for NHG-45 table codes
* a laboratory specific system URL for internal codes.

The use of translations is to be supported predominantly for purposes of duplicate detection, when the same resource comes from various sources into one system. In absence of the relevant identifier, a combination of codes (with translations), effective date and appropriate source identification is sufficient to detect duplicates.

@@ Regel 7: / Regel 7: @@
 <imagemap>Bestand:functioneel-technisch-banner_00_alle.png|center|240px|alt=Functioneel-Technisch
-circle 204 216 215 [[L2z:v4.0.0_ontwerp_lab2zorg|Functional]]
+circle 204 216 215 [[L2z:V4_ontwerp_lab2zorg|Functional]]
-circle 990 216 215 [[L2z:v4.0.0_FHIR_lab2zorg|Technical]]
+circle 990 216 215 [[L2z:V4_FHIR_lab2zorg|Technical]]
 desc none
 </imagemap>

L2z:V4 FHIR lab2zorg - Bewerkingsoverzicht

Marija Zivlak op 7 jul 2026 om 12:30

Marija Zivlak: Nieuwe pagina aangemaakt met ' {{DISPLAYTITLE: Technical Design Lab2zorg v4.0.0-beta.1}} ''The Information Standard Lab Exchange consists of four different components: Lab2Zor...'