Huidige versie van 8 jul 2025 om 09:55

This IG is currently under development and can not be considered stable and ready for use.

1 Introduction

This page describes the technical design of Lab2patient (L2P) as a subset of the Information standard lab exchange (Dutch: Labuitwisseling or abbreviated to LU). This technical specification is implementer centric and complements the functional design. This page uses various terms as defined in the glossary.

1.1 Disclaimers

This page implements general principles applicable to FHIR as outlined by a central FHIR IG for R4. Please make sure you familiarize yourself with both the functional design and the FHIR IG for full appreciation of the context of this page.

This FHIR Implementation Guide assumes that systems (XIS) are able to make a connection to the right systems. It does not provide information on finding the right XIS nor does it provide information about security including authentication and authorization. Finding the right system, and security aspects of the connection, are dealt with by the infrastructure. Any relevant infrastructure is expected to have a framework in place to deal with this. The only assumption/requirement for an infrastructure is that this allows RESTful FHIR-based exchange as specified here.

2 Boundaries and relationships

2.1 Overview of relationships between FHIR resources

2.2 Mappings between profiles and data set

Each transaction starts with links to the functional definition in an ART-DECOR publication and references one or several FHIR profiles. Where the functional definition contains all specific data elements for the transaction (prefixed with ‘lu-concept-v2’), the FHIR profiles only contain a mapping to these data elements that do not have a dependency on a zib counterpart. For example: ‘lu-concept-v2-4266’ (Specimen) has a relation with the zib element with id ‘NL-CM-13.1.2’, therefore no mapping with ‘lu-concept-v2-4266’ can be found in the profiles. On the other hand, ‘lu-concept-v2-4296’ (LaboratoryResultIdentification) has no relation with a zib element, therefore a mapping can be found in the relevant FHIR profile.

Cardinalities in FHIR profiles may be less strict than the ART-DECOR definitions. In this IG, transaction-level cardinalities take precedence. For example: in the nl-core-LaboratoryTestResult profile, .performer has a core cardinality of 0..*, while in both the 'Send laboratory results' and ‘Serve laboratory results’ ART-DECOR transactions, the Performer element has a cardinality of 1..1 M. Therefore, .performer is expected to be filled with a reference to an nl-core-HealthcareProvider-Organization resource.

Each transaction contains a Patient building block with cardinality 1..1 M. This patient is the subject of all other building blocks in the transaction, although no explicit relation exists in the data set. Therefore, a reference to a Patient resource conforming to the nl-core-Patient profile is expected in .subject of each FHIR instance of each building block.

The single zib LaboratoryTestResult consists of objects that in FHIR are represented using different (instances of) resources:

NL-CM:13.1.1 LaboratoryTestResult maps into profile nl-core-LaboratoryTestResult Observation and has .hasMember relationships with individual NL-CM:13.1.3 LaboratoryTests.
- Note that this level only exists when LaboratoryTestResult contains NL-CM:13.1.4 PanelOrBattery. The concepts NL-CM:13.1.7 ResultType, NL-CM:13.1.5 Comment, and NL-CM:13.1.6 ResultStatus are not mapped in the absence of NL-CM:13.1.4 PanelOrBattery.
NL-CM:13.1.3 LaboratoryTest also maps into profile nl-core-LaboratoryTestResult Observation and MAY be referenced by a different Observation.hasMember containing NL-CM:13.1.1 LaboratoryTestResult.
NL-CM:13.1.2 Specimen maps into profile nl-core-LaboratoryTestResult.Specimen Specimen.
- Note that there could be multiple instances of Specimen: one for the main NL-CM:13.1.16 SpecimenMaterial, and one per isolated NL-CM:13.1.22 Microorganism with a .parent relationship to the main specimen.
NL-CM:13.1.29 SpecimenSource maps into profile nl-core-LaboratoryTestResult.Specimen.Source Device. This is a special case where the specimen did not come from the Patient directly.

2.3 FHIR relationship structures

Many laboratory results have important relationships to other observations and need to be grouped together. The FHIR specification defines several structures to do this:

Observation.hasMember
- Each .hasMember element references another Observation and the Observation with .hasMember elements thus serves as grouper for all Observations it references. Each Observation can be accessed individually. This is useful for panels and/or batteries of tests.
- Note that while FHIR Observation also allows references to resource types MolecularSequence and QuestionnaireResponse, there is no identified use case for that at the time of writing.
- An Observation without .hasMember elements is expected to be an individual result and has a value when one can be/is determined.
Observation.derivedFrom
- Each .derivedFrom element references another Observation references related measurements the observation is made from.
- Note that while FHIR Observation also allows references to resource types DocumentReference, ImagingStudy, Media, QuestionnaireResponse and MolecularSequence, there is no identified use case for those at the time of writing.
Observation.component
- .component elements of an Observation are not accessible individually. Whenever you access the Observation, you also access all its components. This is mostly useful when certain context is provided around the result. For lab observations this is expected to be less common. An example outside of the lab realm could be BloodPressure where systolic, diastolic, and cuff size are all in one Observation with 3 components.

2.4 Resource identification

ART-DECOR transactions define a stricter cardinality of 1..1 R for resource identifiers. Therefore:

A stable identifier SHOULD be provided for each resource.
If no identifier value is available, the DataAbsentReason extension SHOULD be used.
Identifiers SHALL contain both a .system and a .value.

For compatibility with HL7v3 (CDA), where identifiers can only be represented as OIDs:

The .system SHALL be an OID to ensure compatibility in transformations to and from FHIR.
The .system SHALL have a maximum of 128 characters.
The .value SHALL have a maximum of 64 characters.

Regarding reference handling:

Systems that encounter or resolve references, either logical or literal, in resources they receive, SHALL NOT rewrite these references to a copy of these resources (with http://nictiz.nl/fhir/StructureDefinition/ext-CopyIndicator present) they may store.
This means that relative literal references MAY need to be rewritten to absolute ones.
The same applies to included secondary resources in transactions.

2.5 FHIR Profile Package

All use cases in this specification depend on the same set of FHIR profiles. FHIR profile package for Lab2Patient is currently in development. The table below lists profiles used within the framework of Lab2Zorg (Lab2Healthcare) that represent applicable zibs for laboratory result information exchange.

Nictiz uses the FHIR Packaging mechanism. This conveniently bundles all profiles, terminology, example material and other conformance resources you need into a single archive, which can be downloaded or installed using the appropriate FHIR tooling. This version of the information standard uses the following packages:

nictiz.fhir.nl.r4.labexchange version 3.0.0-beta.2 or compatible
nictiz.fhir.nl.r4.nl-core version 0.8.0-beta.1 or compatible
nictiz.fhir.nl.r4.zib2020 version 0.6.0-beta.2 or compatible

Note: packages use Semantic Versioning. Other versions can be used at will as long as they have the same major.minor number or a minor number higher than the stated version.

FHIR Profile	FHIR Resource	Based on zib
nl-core-LaboratoryTestResult	Observation	LaboratoryTestResult
nl-core-LaboratoryTestResult.Specimen	Specimen
nl-core-LaboratoryTestResult.Specimen.Source	Device
nl-core-Patient	Patient	Patient
nl-core-HealthcareProvider-Organization	Organization	HealthcareProvider

3 Actors involved

Actors		Systems		FHIR CapabilityStatements
Name	Description	Name	Description	Name	Description
Patient	The user of a personal healthcare environment.	PHR	Personal health record	CapabilityStatement: Lab2Healthcare-Results-RetrieveServe	Retrieve [LAB-LRR-PGO]/serve [LAB-LRB-PGO] lab results requirements.
Lab Professional	The user of a LIS	LIS	Laboratory information system	CapabilityStatement: Lab2Healthcare-Results-RetrieveServe

4 Use cases

4.1 Patient retrieves laboratory results in their PGO

4.1.1 Introduction

This FHIR Implementation Guide assumes that the PHR system is able to make a connection to the right LIS that contains the patient's information. It does not provide information on finding the right LIS nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'Afsprakenstelsel'. Each XIS Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.

4.1.2 Actors

Transaction group	Transaction	Actor	Role
Retrieve laboratory results (PULL)	Retrieve laboratory results request	LaboratoriumresultaatResultaatRaadplegend Systeem [LAB-LRR-PGO]	Send a query to the LAB-LRB-PGO to retrieve lab results
Retrieve laboratory results (PULL)	Retrieve laboratory results response	LaboratoriumresultaatResultaatBeschikbaarstellend Systeem [LAB-LRB-PGO]	Respond to a query from the LAB-LRR-PGO to retrieve lab results

4.1.3 Invocations

4.1.3.1 LAB-LRR-PGO: request message

The request message represents an HTTP GET parameterized query from the PHR (LAB-LRR-PGO) to the LIS (LAB-LRB-PGO).

4.1.3.1.1 Trigger events

When the PHR wants to obtain laboratory results, it issues a retrieve laboratory results request message.

4.1.3.1.2 Message semantics

The PHR (LAB-LRR-PGO) executes an HTTP GET conforming to the FHIR RESTful and search specification against the LIS's Observation endpoint. Laboratory results are all under the .category observation, using query parameter category as token.

Basic query syntax

GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory

Examples

Parameter values have not been uri escaped in these examples for readability. This is likely necessary in practice.

UitvouwenGet all lab results of type 14683-7 (LOINC)
GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category\|laboratory&code=http://loinc.org\|14683-7

UitvouwenGet all lab results of type 14683-7 (LOINC) since March 12, 2022
GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category\|laboratory&code=http://loinc.org\|14683-7&date=gt2022-03-12

UitvouwenGet all lab results of type 14683-7 (LOINC) since March 12, 2022 but before June 7, 2022
GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category\|laboratory&code=http://loinc.org\|14683-7&date=gt2022-03-12&date=lt2022-06-07

UitvouwenGet all lab results of type 14683-7 (LOINC) and/or 3583 (NHG)

UitvouwenGet latest lab result of type 14683-7 (LOINC)
GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category\|laboratory&code=http://loinc.org\|14683-7

UitvouwenGet latest 5 lab results of type 14683-7 (LOINC)
GET [base]/Observation/$lastn?max=5&category=http://terminology.hl7.org/CodeSystem/observation-category\|laboratory&code=http://loinc.org\|14683-7

UitvouwenGet latest lab result of any type
GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category\|laboratory

4.1.3.1.2.1 Expected actions

The LIS (LAB-LRB-PGO) SHALL process the query to retrieve laboratory results.

4.1.3.2 LAB-LRB-PGO: response message

The LIS (LAB-LRB-PGO) returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching information. Refer to the generic FHIR IG for more information on handling errors and status codes. Not finding a match based on stated parameters does not constitute an error.

4.1.3.2.1 Trigger events

The LIS (LAB-LRB-PGO) completed the processing of the retrieve laboratory results request message.

4.1.3.2.2 Message semantics

The LIS (LAB-LRB-PGO) SHALL process the request and, unless an error is found, respond with a Bundle resource of type searchset. Each Observation matching the request SHALL be marked with .entry.search.mode=match. Each otherwise included resource SHALL be marked with .entry.search.mode=include. If the searchset bundle contains less matching resources than the actual total set, then:

the Bundle.link that holds the self link, SHOULD include the _count parameter to inform the client of what max was applied
an OperationOutcome SHOULD be included marked with .entry.search.mode=outcome.

The resources in the response Bundle SHALL be a valid instance of their stated profile. All resources SHALL include their related profile canonical URL in the .meta.profile element in order to show compliance. The exception is the OperationOutcome resource for which there is no profile in this specification.

Example searchset Bundle

UitvouwenXML contents for searchset Bundle

<Bundle xmlns="http://hl7.org/fhir">
    <id value="1"/>
    <type value="searchset"/>
    <total value="3"/>
    <link>
        <relation value="self"/>
        <url value="http://example.org/fhir?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&amp;patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&amp;code=http://loinc.org|14683-7"/>
    </link>
    <entry>
        <fullUrl value="https://example.org/fhir/Observation/1"/>
        <resource>
            <Observation>
                <!--  -->
            </Observation>
        </resource>
        <search>
            <mode value="match"/>
        </search>
    </entry>
    <entry>
        <fullUrl value="https://example.org/fhir/Observation/2"/>
        <resource>
            <Observation>
                <!--  -->
            </Observation>
        </resource>
        <search>
            <mode value="match"/>
        </search>
    </entry>
    <entry>
        <fullUrl value="https://example.org/fhir/Observation/3"/>
        <resource>
            <resource>
                <Observation>
                    <!--  -->
                </Observation>
            </resource>
        </resource>
        <search>
            <mode value="match"/>
        </search>
    </entry>
    <entry>
        <fullUrl value="https://example.org/fhir/Specimen/1"/>
        <resource>
            <Specimen>
                <!--  -->
            </Specimen>
        </resource>
        <search>
            <mode value="include"/>
        </search>
    </entry>
    <entry>
        <fullUrl value="https://example.org/fhir/Patient/1"/>
        <resource>
            <Patient>
                <!--  -->
            </Patient>
        </resource>
        <search>
            <mode value="include"/>
        </search>
    </entry>
    <entry>
        <fullUrl value="https://example.org/fhir/Organization/1"/>
        <resource>
            <Organization>
                <!--  -->
            </Organization>
        </resource>
        <search>
            <mode value="include"/>
        </search>
    </entry>
</Bundle>

Example OperationOutcome

UitvouwenXML contents for OperationOutcome

4.1.3.2.3 LAB-LRB-PGO: Expected actions

The LIS (LAB-LRB-PGO) SHALL process the response Bundle in accordance with the intentions of the trigger event that caused the retrieve. Actions may include discrete rendering on screen or in context with other information, triggering alerts on trends, ordering of (other) tests and more.

Lab:V1.0 FHIR Lab2Patient: verschil tussen versies

Huidige versie van 8 jul 2025 om 09:55

Inhoud

1 Introduction

1.1 Disclaimers

2 Boundaries and relationships

2.1 Overview of relationships between FHIR resources

2.2 Mappings between profiles and data set

2.3 FHIR relationship structures

2.4 Resource identification

2.5 FHIR Profile Package

3 Actors involved

4 Use cases

4.1 Patient retrieves laboratory results in their PGO

4.1.1 Introduction

4.1.2 Actors

4.1.3 Invocations

4.1.3.1 LAB-LRR-PGO: request message

4.1.3.1.1 Trigger events

4.1.3.1.2 Message semantics

4.1.3.1.2.1 Expected actions

4.1.3.2 LAB-LRB-PGO: response message

4.1.3.2.1 Trigger events

4.1.3.2.2 Message semantics

4.1.3.2.3 LAB-LRB-PGO: Expected actions

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@@ Regel 1: / Regel 1: @@
 {{Vdraft/InformationBox|This IG is currently under development and can not be considered stable and ready for use.}}
-{{DISPLAYTITLE:FHIR Lab2patient V1.0.0}}
+{{DISPLAYTITLE:FHIR Implementation Guide Lab2patient V1.0.0 - alpha}}
 <!--{{underconstruction}}-->
@@ Regel 15: / Regel 15: @@
 [[Bestand:Functioneel-02.png|link=Lab:V1.0_Ontwerp_Lab2Patient|100px|rechts|Functional design|Go to functional design]]
-This page describes the technical design of Lab2patient (Lab2patient) as a subset of the '''[[Lab:V3.0.0 Ontwerp Laboverdacht|Information standard lab exchange]]'''. This technical specification is implementer centric and complements the '''[[Lab:V1.0_Ontwerp_Lab2Patient|functional design]]'''. This page uses various terms as defined in the [[Lab:V3.0.0 Ontwerp Laboverdacht#Begrippenlijst|glossary]] (Dutch: Begrippenlijst). This page implements general principles applicable to FHIR as outlined by a central [[FHIR:V1.0_FHIR_IG_R4|FHIR IG for R4]]. Please make sure you familiarize yourself with both the functional design and the FHIR IG for full appreciation of the context of this page.
+This page describes the technical design of Lab2patient (L2P) as a subset of the '''[[Lab:V3.0.0 Ontwerp Laboverdacht|Information standard lab exchange]]''' (Dutch: Labuitwisseling or abbreviated to LU). This technical specification is implementer centric and complements the '''[[Lab:V1.0_Ontwerp_Lab2Patient|functional design]]'''. This page uses various terms as defined in the [[Lab:V3.0.0 Ontwerp Laboverdacht#Begrippenlijst|glossary]].
-Many laboratory results have important relationships to other observations and need to be grouped together. [http://hl7.org/fhir/r4/observation.html#10.1.4.1 The FHIR specification] defines several structures to do this:
+==Disclaimers==
+This page implements general principles applicable to FHIR as outlined by a central [[FHIR:V1.0_FHIR_IG_R4|FHIR IG for R4]]. Please make sure you familiarize yourself with both the functional design and the FHIR IG for full appreciation of the context of this page.
-* {{fhir|Observation}} and one or more {{fhir|Observation.hasMember}} elements.
-** Each {{fhir|.hasMember}} element references another Observation and the Observation with {{fhir|.hasMember}} elements thus serves as grouper for all Observations it references. Each Observation can be accessed individually. This is useful for panels and/or batteries of tests. This is what [https://zibs.nl/wiki/LaboratoryTestResult-v4.6(2020EN)#12870 NL-CM:13.1.3 LaboratoryTest] maps into.
-** Note that while FHIR Observation also allows references to resource types MolecularSequence and QuestionnaireResponse, there is no identified use case for that at time of writing.
-** An Observation without {{fhir|.hasMember}} elements is expected to be an individual result and has a value when one can be/is determined.
-* {{fhir|Observation}} and one or more {{fhir|Observation.derivedFrom}} elements.
-** Each {{fhir|.derivedFrom}} element references another Observation references related measurements the observation is made from. This is what [https://zibs.nl/wiki/LaboratoryTestResult-v4.6(2020EN)#12849 NL-CM:13.1.33 RelatedResult::LaboratoryTestResult] maps into.
-** Note that while FHIR Observation also allows references to resource types DocumentReference, ImagingStudy, Media, QuestionnaireResponse and MolecularSequence, there is no identified use case for those at time of writing.
-* {{fhir|Observation}} and one or more {{fhir|Observation.component}} elements.
-** {{fhir|.component}}s of an Observation are not accessible individually. Whenever you access the Observation, you also access all its components. This is mostly useful when certain context is provided around the result. For lab observations this is expected to be less common. An example outside of the lab realm could be BloodPressure where systolic, diastolic, and cuff size are all in one Observation with 3 components.
-This FHIR implementation guide assumes that systems (XIS) are able to make a connection to the right systems. It does not provide information on finding the right XIS nor does it provide information about security including authentication and authorization. Finding the right system, and security aspects of the connection, are dealt with by the infrastructure. Any relevant infrastructure is expected to have a framework in place to deal with this. The only assumption/requirement for an infrastructure is that this allows RESTful FHIR-based exchange as specified here.
+This FHIR Implementation Guide assumes that systems (XIS) are able to make a connection to the right systems. It does not provide information on finding the right XIS nor does it provide information about security including authentication and authorization. Finding the right system, and security aspects of the connection, are dealt with by the infrastructure. Any relevant infrastructure is expected to have a framework in place to deal with this. The only assumption/requirement for an infrastructure is that this allows RESTful FHIR-based exchange as specified here.
 =Boundaries and relationships=
+==Overview of relationships between FHIR resources==
+[[Bestand:LaboratoryInFHIRR4Overview.png||Laboratory results in FHIR R4 overview]]
 ==Mappings between profiles and data set==
-Each transaction starts with links to the functional definition in an ART-DECOR publication and references one or several FHIR profiles. Where the functional definition contains all specific data elements for the transaction (prefixed with ‘lu-concept-v2’), the FHIR profiles only contain a mapping to these data elements that do not have a dependency on a zib counterpart. For example: ‘lu-concept-v2-4266’ (Specimen) has a relation with the zib element with id ‘NL-CM-13.1.2’, therefore no mapping with ‘lu-concept-v2-4266’ can be found in the profiles. On the other hand, ‘lu-concept-v2-4296’ (LaboratoryResultIdentification) has no relation with a zib element, therefore a mapping can be found in the relevant FHIR profile.
+Each transaction starts with links to the [https://decor.nictiz.nl/ad/#/lu-/scenarios/scenarios/2.16.840.1.113883.2.4.3.11.60.25.3.5/2024-09-16T00:00:00 functional definition in an ART-DECOR publication] and references one or several FHIR profiles. Where the functional definition contains all specific data elements for the transaction (prefixed with ‘lu-concept-v2’), the FHIR profiles only contain a mapping to these data elements that do not have a dependency on a zib counterpart. For example: ‘lu-concept-v2-4266’ (Specimen) has a relation with the zib element with id ‘NL-CM-13.1.2’, therefore no mapping with ‘lu-concept-v2-4266’ can be found in the profiles. On the other hand, ‘lu-concept-v2-4296’ (LaboratoryResultIdentification) has no relation with a zib element, therefore a mapping can be found in the relevant FHIR profile.
-Because of [[FHIR:V1.0_FHIR_Profiling_Guidelines_R4#Open_vs._closed_world_modeling|open world modeling]], the cardinality of elements in the FHIR profiles can be less strict than the cardinalities in the ART-DECOR transactions. However, the latter cardinality is leading when it comes to exchanging building blocks in the context of a specific transaction. For example: in the nl-core-LaboratoryTestResult profile, {{fhir|.performer}} has a core cardinality of 0..*, while in both the 'Send laboratory results' and ‘Serve laboratory results’ ART-DECOR transactions, the Performer element has a cardinality of 1..1 M. Therefore, {{fhir|.performer}} is expected to be filled with either a reference to an nl-core-HealthcareProvider-Organization resource.
+Cardinalities in FHIR profiles may be less strict than the ART-DECOR definitions. In this IG, transaction-level cardinalities take precedence. For example: in the nl-core-LaboratoryTestResult profile, {{fhir|.performer}} has a core cardinality of 0..*, while in both the 'Send laboratory results' and ‘Serve laboratory results’ ART-DECOR transactions, the Performer element has a cardinality of 1..1 M. Therefore, {{fhir|.performer}} is expected to be filled with a reference to an nl-core-HealthcareProvider-Organization resource.
 Each transaction contains a Patient building block with cardinality 1..1 M. This patient is the subject of all other building blocks in the transaction, although no explicit relation exists in the data set. Therefore, a reference to a Patient resource conforming to the nl-core-Patient profile is expected in {{fhir|.subject}} of each FHIR instance of each building block.
-[[Bestand:LaboratoryInFHIRR4Overview.png|miniatuur|Laboratory results in FHIR R4 overview]]
 The single zib LaboratoryTestResult consists of objects that in FHIR are represented using different (instances of) resources:
@@ Regel 49: / Regel 40: @@
 * ''NL-CM:13.1.29 SpecimenSource'' maps into profile {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-LaboratoryTestResult.Specimen.Source|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.6.0-beta.2|title=nl-core-LaboratoryTestResult.Specimen.Source}} {{fhir|Device}}. This is a special case where the specimen did not come from the Patient directly.
-==Patient identification==
+==FHIR relationship structures==
-This implementation guide assumes that the client system is able to make a connection to the right server that contains the patient's information. It does not provide information on finding the right server nor does it provide information about security. Moreover, each transaction is performed in the context of a specific (authenticated) patient, whose context might have been established using the authentication mechanisms described in external specifications such as the MedMij 'Afsprakenstelsel' or through the usage of search parameters for patient identification. Each server is required to perform filtering based on the patient associated with the context for the request or based on the patient identification search parameters, so only the records associated with the authenticated patient are returned.
+Many laboratory results have important relationships to other observations and need to be grouped together. [http://hl7.org/fhir/r4/observation.html#10.1.4.1 The FHIR specification] defines several structures to do this:
-When patient identification requires the use of search parameters, the following search parameters SHALL be supported:
+* {{fhir|Observation.hasMember}}
+** Each {{fhir|.hasMember}} element references another Observation and the Observation with {{fhir|.hasMember}} elements thus serves as grouper for all Observations it references. Each Observation can be accessed individually. This is useful for panels and/or batteries of tests.
-* Patient: {{fhir|identifier}}
+** Note that while FHIR Observation also allows references to resource types MolecularSequence and QuestionnaireResponse, there is no identified use case for that at the time of writing.
-* Observation: {{fhir|patient}}
+** An Observation without {{fhir|.hasMember}} elements is expected to be an individual result and has a value when one can be/is determined.
+* {{fhir|Observation.derivedFrom}}
-An example of a request that retrieves all Observation resources of a patient with a fake BSN of 11122233:
+** Each {{fhir|.derivedFrom}} element references another Observation references related measurements the observation is made from.
+** Note that while FHIR Observation also allows references to resource types DocumentReference, ImagingStudy, Media, QuestionnaireResponse and MolecularSequence, there is no identified use case for those at the time of writing.
-<pre>GET [base]/Observation?patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333</pre>
+* {{fhir|Observation.component}}
+** {{fhir|.component}} elements of an Observation are not accessible individually. Whenever you access the Observation, you also access all its components. This is mostly useful when certain context is provided around the result. For lab observations this is expected to be less common. An example outside of the lab realm could be BloodPressure where systolic, diastolic, and cuff size are all in one Observation with 3 components.
 ==Resource identification==
-All profiles used within the information standard contain {{fhir|.identifier}} elements with a cardinality of 0..* because of open world modeling. However, all ART-DECOR transactions referenced within this IG assign a 1..1 R cardinality, meaning a stable identifier SHOULD be provided, or [[FHIR:V0.9_FHIR_IG_R4#Missing_information|the DataAbsentReason extension if a value is missing]]. Identifiers SHALL contain both a {{fhir|.system}} and a {{fhir|.value}}.
+ART-DECOR transactions define a stricter cardinality of 1..1 R for resource identifiers. Therefore:
+* A stable identifier SHOULD be provided for each resource.
+* If no identifier value is available, [[FHIR:V0.9_FHIR_IG_R4#Missing_information|the DataAbsentReason extension]] SHOULD be used.
+* Identifiers SHALL contain both a {{fhir|.system}} and a {{fhir|.value}}.
-Because in HL7v3 (CDA) an identifier can only be composed using [[Hoofdpagina#Object_IDentifiers_.28OIDs.29|OIDs]], the {{fhir|.system}} SHALL be an OID to accommodate compatibility in transformations to and from FHIR. The [https://www.hl7.nl/wiki/index.php?title=DatatypesR1:II Dutch HL7v3 datatype variant of II] also defines additional restrictions on the maximum length of both <code>@root</code> and <code>@extension</code> (equivalent to respectively {{fhir|.system}} and {{fhir|.value}} in FHIR). For the same compatibility reasons, {{fhir|.system}} SHALL have a maximum of 128 characters and {{fhir|.value}} SHALL have a maximum of 64 characters.
+For compatibility with HL7v3 (CDA), where identifiers can only be represented as [[Hoofdpagina#Object_IDentifiers_.28OIDs.29|OIDs]]:
+* The {{fhir|.system}} SHALL be an OID to ensure compatibility in transformations to and from FHIR.
+* The {{fhir|.system}} SHALL have a maximum of 128 characters.
+* The {{fhir|.value}} SHALL have a maximum of 64 characters.
-Systems that encounter or resolve references, either logical or literal, in resources they receive, SHALL NOT rewrite these references to a copy of these resources (with {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/ext-CopyIndicator|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.6.0-beta.2}} present) they may store. This means that [https://hl7.org/fhir/r4/references.html relative literal references] may need to be rewritten to absolute ones. This also goes for [[FHIR:V1.0_FHIR_IG_R4#Including_.22secondary.22_resources_when_sending_information|included secondary resources in transactions]].
+Regarding reference handling:
+* Systems that encounter or resolve references, either logical or literal, in resources they receive, SHALL NOT rewrite these references to a copy of these resources (with {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/ext-CopyIndicator|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.6.0-beta.2}} present) they may store.
+* This means that [https://hl7.org/fhir/r4/references.html relative literal references] MAY need to be rewritten to absolute ones.
+* The same applies to [[FHIR:V1.0_FHIR_IG_R4#Including_.22secondary.22_resources_when_sending_information|included secondary resources in transactions]].
 ==FHIR Profile Package==
-All use cases in this specification depend on the same set of FHIR profiles. The table below lists profiles that represent applicable zibs for laboratory result information exchange.
+<!-- If you change this section title, also change the links to it on the pages ... -->
+All use cases in this specification depend on the same set of FHIR profiles. FHIR profile package for Lab2Patient is currently in development. The table below lists profiles used within the framework of Lab2Zorg (Lab2Healthcare) that represent applicable zibs for laboratory result information exchange.
 {{NoteBoxNictizR4Package|p1=nictiz.fhir.nl.r4.labexchange|v1=3.0.0-beta.2|p2=nictiz.fhir.nl.r4.nl-core|v2=0.8.0-beta.1|p3=nictiz.fhir.nl.r4.zib2020|v3=0.6.0-beta.2}}
-{| class="wikitable" style="min-width:90%;"
+{| class="wikitable"
-|-style="background-color:#1F497D; color:white; font-weight:bold;"
+! style="text-align:left;" | FHIR Profile
-|FHIR Profile
+! style="text-align:left;" | FHIR Resource
-|FHIR Resource
+! style="text-align:left;" | Based on zib
-|style="min-width:150px;"|Based on zib (EN)
 |-
 | {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-LaboratoryTestResult|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.6.0-beta.2|title=nl-core-LaboratoryTestResult}}
 | Observation
-| rowspan="3" | LaboratoryResult
+| rowspan="3" | [https://zibs.nl/wiki/LaboratoryTestResult-v4.6(2020EN) LaboratoryTestResult]
 |-
 | {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-LaboratoryTestResult.Specimen|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.6.0-beta.2|title=nl-core-LaboratoryTestResult.Specimen}}
@@ Regel 90: / Regel 91: @@
 |-
 | {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.r4.nl-core|pkgVersion=0.6.0-beta.2|title=nl-core-Patient}}
-|Patient
+| Patient
-|Patient
+| [https://zibs.nl/wiki/Patient-v3.2(2020EN) Patient]
 |-
 | {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization|nictiz.fhir.nl.r4.nl-core|title=nl-core-HealthcareProvider-Organization}}
-|Organization
+| Organization
-|HealthcareProvider
+| [https://zibs.nl/wiki/HealthcareProvider-v3.4(2020EN) HealthcareProvider]
 |}
 =Actors involved=
-{| class="wikitable"
-! colspan="2" style="text-align:left;" | Persons
-! colspan="2" style="text-align:left;" | Systems
-! colspan="2" style="text-align:left;" | FHIR Capability Statements
-|-
-! style="text-align:left;" |Name
-! style="text-align:left;" |Description
-! style="text-align:left;" |Name
-! style="text-align:left;" |Description
-! style="text-align:left;" |Name
-! style="text-align:left;" |Description
-|-
-| rowspan="2" | Lab Professional
-| rowspan="2" | The user of a LIS
-| rowspan="2" | LIS
-| rowspan="2" | Laboratory information system
-| [[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/Lab2Healthcare-Results-RetrieveServe|nictiz.fhir.nl.r4.labexchange|pkgVersion=3.0.0-beta.1|title=CapabilityStatement: Lab2Healthcare-Results-RetrieveServe}}
-| Retrieve [LAB-LRR]/serve [LAB-LRB] lab results requirements. A LIS is only expected to serve results in the context of Lab2zorg.
-|-
-| [[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/Lab2Healthcare-Results-SendReceive|nictiz.fhir.nl.r4.labexchange|pkgVersion=3.0.0-beta.1|title=CapabilityStatement: Lab2Healthcare-Results-SendReceive}}
-| Send [LAB-LRS]/receive [LAB-LRO] lab results requirements. A LIS is only expected to send results in the context of Lab2zorg.
-|-
-| rowspan="2" | Patient
-| rowspan="2" | The user of a personal healthcare environment
-| rowspan="2" | PHR
-| rowspan="2" | Personal health record
-| [[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/Lab2Healthcare-Results-RetrieveServe|nictiz.fhir.nl.r4.labexchange|pkgVersion=3.0.0-beta.1|title=CapabilityStatement: Lab2Healthcare-Results-RetrieveServe}}
-| Retrieve [LAB-LRR]/serve [LAB-LRB] lab results requirements. A XIS may both retrieve results and serve copies of results in the context of Lab2zorg.
-|-
-| [[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/Lab2Healthcare-Results-SendReceive|nictiz.fhir.nl.r4.labexchange|pkgVersion=3.0.0-beta.1|title=CapabilityStatement: Lab2Healthcare-Results-SendReceive}}
-| Send [LAB-LRS]/receive [LAB-LRO] lab results requirements. A XIS may both send copies of results and receive (copies of) results in the context of Lab2zorg.
-|}
 {| class="wikitable"
 ! colspan="2" style="text-align:left;font-weight: bold;" | Actors
@@ Regel 159: / Regel 127: @@
 =Use cases=
-==Health professional retrieves lab results==
+==Patient retrieves laboratory results in their PGO==
 ===Introduction===
-Healthcare professionals need to be able to retrieve laboratory results directly from a lab (LIS) or a secondary healthcare provider (XIS). Different healthcare professionals may have different needs and/or authorizations. The core FHIR specification offers support for a lot of use cases. This specification only outlines options for the identified scope and associated minimal expectations. As such it is ''not'' intended to be limiting to said expectations. Servers SHALL use the CapabilityStatement to advertise their implementation and clients SHOULD use this as means to discover the servers capabilities as per the FHIR specification, as well as publish their own capabilities. <nowiki>[</nowiki>[http://hl7.org/fhir/r4/http.html#3.1.0 FHIR RESTful]<nowiki>]</nowiki> / <nowiki>[</nowiki>[http://hl7.org/fhir/r4/capabilitystatement.html#notes CapabilityStatement]<nowiki>]</nowiki>.
+This FHIR Implementation Guide assumes that the PHR system is able to make a connection to the right LIS that contains the patient's information. It does not provide information on finding the right LIS nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the [https://www.medmij.nl/afsprakenstelsel/ 'Afsprakenstelsel']. Each XIS Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.
-The identified use cases within the scope of this implementation guide are very broad:
-* Get latest X results for one or more specific {{fhir|Observation.code}}s
-* Get latest X results for any {{fhir|Observation.code}}s
-* Get results on/before/after date X
-* Get results on/before/after date X for one or more specific {{fhir|Observation.code}}s
-Each server SHALL perform filtering based on the patient, and results associated with the request context and patient identification search parameters, so only the records are returned that the requesting party is authorized for. Example expectations are that any ordering provider will have access to results related to his orders, and any requesting party interested in medication related results only has access to those.
-A special word of caution about volume. It has been proven hard to impossible to define an optimum on how much history should be supported. For example some genetic tests are done once at age 15, and are still valid at age 80. Returning ''all'' results for someone age 80 could take an enormous toll on both server and client and is seldom relevant. Clients are therefore encouraged to be as specific as possible, by using both {{fhir|code}} and/or {{fhir|date}} and/or [https://www.hl7.org/fhir/r4/search.html#count {{fhir|_count}}] whenever possible. Servers SHOULD implement [https://www.hl7.org/fhir/r4/search.html#count {{fhir|_count}}], and SHOULD implement an OperationOutcome that informs the client of a partial result set when the total number exceeds what a server will handle.
 ===Actors===
-{| class="wikitable" "cellpadding="10"
+{| class="wikitable"
-! style="text-align:left;"| '''Transaction group'''
+! style="text-align:left;" | Transaction group
-! style="text-align:left;"| '''Transaction'''
+! style="text-align:left;" | Transaction
-! style="text-align:left;"| '''Actor'''
+! style="text-align:left;" | Actor
-! style="text-align:left;"| '''Role'''
+! style="text-align:left;" | Role
 |-
-|style="background-color: white;vertical-align:top;" rowspan="2"|Retrieve laboratory results (PULL)
+| rowspan="2" | Retrieve laboratory results (PULL)
-|style="background-color: white;vertical-align:top;"|Retrieve laboratory results request
+| Retrieve laboratory results request
-|style="background-color: white;vertical-align:top;"|LaboratoriumresultaatResultaatRaadplegend Systeem [LAB-LRR]
+| LaboratoriumresultaatResultaatRaadplegend Systeem [LAB-LRR-PGO]
-|style="background-color: white;vertical-align:top;"|Send a query to the LAB-LRB to retrieve lab results
+| Send a query to the LAB-LRB-PGO to retrieve lab results
 |-
-|style="background-color: white;vertical-align:top;"|Retrieve laboratory results response
+| Retrieve laboratory results response
-|style="background-color: white;vertical-align:top;"|LaboratoriumresultaatResultaatBeschikbaarstellend Systeem [LAB-LRB]
+| LaboratoriumresultaatResultaatBeschikbaarstellend Systeem [LAB-LRB-PGO]
-|style="background-color: white;vertical-align:top;"|Respond to a query from the LAB-LRR to retrieve lab results
+| Respond to a query from the LAB-LRR-PGO to retrieve lab results
 |}
 ===Invocations===
-====LAB-LRR: request message====
+====LAB-LRR-PGO: request message====
-The request message represents an HTTP GET parameterized query from the XIS (LAB-LRR) to the XIS/LIS (LAB-LRB).
+The request message represents an HTTP GET parameterized query from the PHR (LAB-LRR-PGO) to the LIS (LAB-LRB-PGO).
 =====Trigger events=====
-When the healthcare professional wants to obtain laboratory results, it issues a retrieve laboratory results request message.
+When the PHR wants to obtain laboratory results, it issues a retrieve laboratory results request message.
 =====Message semantics=====
-The XIS (LAB-LRR) executes an HTTP GET conforming to the FHIR [http://hl7.org/fhir/r4/http.html RESTful] and [http://hl7.org/fhir/r4/search.html search] specification against the XIS/LIS's Observation endpoint.
+The PHR (LAB-LRR-PGO) executes an HTTP GET conforming to the FHIR [http://hl7.org/fhir/r4/http.html RESTful] and [http://hl7.org/fhir/r4/search.html search] specification against the LIS's Observation endpoint. Laboratory results are all under the {{fhir|.category}} ''observation'', using query parameter {{fhir|category}} as token.
-* Laboratory results are all under the {{fhir|.category}} ''observation'', using query parameter {{fhir|category}} as token.
-* Requesting data for a specific {{fhir|.subject}} is done using query parameter {{fhir|patient}} as reference, or on some network infrastructures with an authorization token. The FHIR query parameter type [https://www.hl7.org/fhir/r4/search.html#reference reference] can take on many forms.
-** If you know what the {{fhir|Patient.id}} is, e.g. from previous interactions with the same endpoint, you may use:
-*** {{fhir|<nowiki>patient=[id]</nowiki>}}
-*** {{fhir|<nowiki>patient=[type]/[id]</nowiki>}}
-*** {{fhir|<nowiki>patient=[url]</nowiki>}}
-** If you don't know what the {{fhir|Patient.id}} is, but you know the {{fhir|Patient.identifier}}, e.g. the Burgerservicenummer (BSN), you may use:
-*** {{fhir|<nowiki>patient:identifier=[system]|[value]</nowiki>}}
-* Requesting laboratory results of a specific type is done using query parameter {{fhir|code}} as token.
-* Requesting laboratory results of a specific date (range) is done using query parameter {{fhir|date}} as token.
 '''Basic query syntax'''
-<pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory{&patient=Patient/[id] | &patient:identifier=[system]|[value]}{&[parameter(s)]&_include=[resource(s)]}</pre>
+<pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory</pre>
 '''Examples'''
@@ Regel 219: / Regel 165: @@
 Parameter values have not been uri escaped in these examples for readability. This is likely necessary in practice.
-{{Collapse top|Get all lab results of type 14683-7 (LOINC) for patient with BSN 111222333}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;
-<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="text-align: left;" | Get all lab results of type 14683-7 (LOINC)
-{{Collapse bottom}}
+|-
+| <pre>
+GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7
+</pre>
+|}
-{{Collapse top|Get all lab results of type 14683-7 (LOINC) for patient with BSN 111222333 since March 12, 2022}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;
-<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=gt2022-03-12</pre>
+! style="text-align: left;" | Get all lab results of type 14683-7 (LOINC) since March 12, 2022
-{{Collapse bottom}}
+|-
+| <pre>
+GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7&date=gt2022-03-12
+</pre>
+|}
-{{Collapse top|Get all lab results of type 14683-7 (LOINC) for patient with BSN 111222333 since March 12, 2022 but before June 7, 2022}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;
-<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=gt2022-03-12&date=lt2022-06-07</pre>
+! style="text-align: left;" | Get all lab results of type 14683-7 (LOINC) since March 12, 2022 but before June 7, 2022
-{{Collapse bottom}}
+|-
+| <pre>
+GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7&date=gt2022-03-12&date=lt2022-06-07
+</pre>
+|}
-{{Collapse top|Get all lab results of type 14683-7 (LOINC) and/or 3583 (NHG) for patient with BSN 111222333}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;
-<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="text-align: left;" | Get all lab results of type 14683-7 (LOINC) and/or 3583 (NHG)
-{{Collapse bottom}}
+|-
+| <pre>
+GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7,https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|3583
+</pre>
+|}
-{{Collapse top|Get latest lab result of type 14683-7 (LOINC) for patient with BSN 111222333}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;
-<pre>GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7</pre>
+! style="text-align: left;" | Get latest lab result of type 14683-7 (LOINC)
-{{Collapse bottom}}
+|-
+| <pre>
+GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7
+</pre>
+|}
-{{Collapse top|Get latest 5 lab results of type 14683-7 (LOINC) for patient with BSN 111222333}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;
-<pre>GET [base]/Observation/$lastn?max=5&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7</pre>
+! style="text-align: left;" | Get latest 5 lab results of type 14683-7 (LOINC)
-{{Collapse bottom}}
+|-
+| <pre>
+GET [base]/Observation/$lastn?max=5&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7
+</pre>
+|}
-{{Collapse top|Get latest lab result of any type for patient with BSN 111222333}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;
-<pre>GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333</pre>
+! style="text-align: left;" | Get latest lab result of any type
-{{Collapse bottom}}
+|-
+| <pre>
-'''Query parameters overview'''
+GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory
+</pre>
-Servers SHALL at minimum support all stated parameters and modifiers, and MAY support additional parameters and modifiers. Clients SHALL support required parameters, and MAY support optional parameters.
+|}
-* {{fhir|category}} - token - 1..1 required - fixed value ''<nowiki>http://terminology.hl7.org/CodeSystem/observation-category|laboratory</nowiki>''
-* {{fhir|patient}} - token - 0..1 conditional - required if not solved using an alternative method like an authorization token
-** Modifier {{fhir|:identifier}} - 0..1 optional - required when searching by identifier
-* {{fhir|code}} - token - 0..1 optional
-* {{fhir|date}} - date - 0..1 optional
-** Prefix {{fhir|eq}} - 0..1 optional - required when searching for results with {{fhir|.effective}} on exact date
-** Prefix {{fhir|lt}} - 0..1 optional - required when searching for results with {{fhir|.effective}} before date
-** Prefix {{fhir|le}} - 0..1 optional - required when searching for results with {{fhir|.effective}} on or before date
-** Prefix {{fhir|gt}} - 0..1 optional - required when searching for results with {{fhir|.effective}} after date
-** Prefix {{fhir|ge}} - 0..1 optional - required when searching for results with {{fhir|.effective}} on or after date
-* {{fhir|_count}} - positiveInt - 0..1 optional
-* {{fhir|_include}} - reference - 0..* optional - useful for request to include secondary related resources, e.g.:<br/>{{fhir|<nowiki>_include=Observation:patient,Observation:performer,Observation:has-member,Observation:specimen</nowiki>}}
-** Note that servers MAY, depending on their read capabilities, choose to implement inclusion of resources regardless of a client requesting this to satisfy the [[FHIR:V1.0_FHIR_IG_R4|generic requirement]] that references SHALL be resolvable.
-'''Operations'''
-* [https://www.hl7.org/fhir/r4/observation-operation-lastn.html {{fhir|lastn}}] - shortcut FHIR core operation for getting the latest X results of specified types, or 'any' type
-** Parameter {{fhir|max}} - positiveInt - optional - default is {{fhir|<nowiki>max=1</nowiki>}}
 ======Expected actions======
-The XIS/LIS (LAB-LRB) SHALL process the query to retrieve laboratory results.
+The LIS (LAB-LRB-PGO) SHALL process the query to retrieve laboratory results.
-====LAB-LRB: response message====
+====LAB-LRB-PGO: response message====
-The XIS/LIS (LAB-LRB) returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching information. Refer to the generic [[FHIR:V1.0_FHIR_IG_R4|FHIR IG]] for more information on handling errors and status codes. Not finding a match based on stated parameters does not constitute an error.
+The LIS (LAB-LRB-PGO) returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching information. Refer to the generic [[FHIR:V1.0_FHIR_IG_R4|FHIR IG]] for more information on handling errors and status codes. Not finding a match based on stated parameters does not constitute an error.
 =====Trigger events=====
-The XIS/LIS (LAB-LRB) completed the processing of the retrieve laboratory results request message.
+The LIS (LAB-LRB-PGO) completed the processing of the retrieve laboratory results request message.
 =====Message semantics=====
-The XIS/LIS (LAB-LRB) SHALL process the request and, unless an error is found, respond with a Bundle resource of type ''searchset''. Each Observation matching the request SHALL be marked with {{fhir|.entry.search.mode}}={{term|match}}. Each otherwise included resource SHALL be marked with {{fhir|.entry.search.mode}}={{term|include}}. If the searchset bundle contains less '''matching''' resources than the actual total set, then:
+The LIS (LAB-LRB-PGO) SHALL process the request and, unless an error is found, respond with a Bundle resource of type ''searchset''. Each Observation matching the request SHALL be marked with {{fhir|.entry.search.mode}}={{term|match}}. Each otherwise included resource SHALL be marked with {{fhir|.entry.search.mode}}={{term|include}}. If the searchset bundle contains less '''matching''' resources than the actual total set, then:
 * the {{fhir|Bundle.link}} that holds the self link, SHOULD include the {{fhir|_count}} parameter to inform the client of what max was applied
 * an OperationOutcome SHOULD be included marked with {{fhir|.entry.search.mode}}={{term|outcome}}.
@@ Regel 287: / Regel 239: @@
 '''Example searchset Bundle'''
-{{Collapse top|XML contents for searchset Bundle}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;"
-<syntaxhighlight lang="xml">
+! style="text-align: left;" | XML contents for searchset Bundle
+|-
+| <syntaxhighlight lang="xml">
 <Bundle xmlns="http://hl7.org/fhir">
      <id value="1"/>
@@ Regel 367: / Regel 321: @@
 </Bundle>
 </syntaxhighlight>
-{{Collapse bottom}}
+|}
 '''Example OperationOutcome'''
-{{Collapse top|XML contents for OperationOutcome}}
+{| class="wikitable mw-collapsible mw-collapsed" style="width:100%; table-layout:fixed;"
-<syntaxhighlight lang="xml">
+! style="text-align: left;" | XML contents for OperationOutcome
+|-
+| <syntaxhighlight lang="xml">
 <OperationOutcome xmlns="http://hl7.org/fhir">
      <id value="size-exceeded-1"/>
@@ Regel 384: / Regel 340: @@
 </OperationOutcome>
 </syntaxhighlight>
-{{Collapse bottom}}
+|}
-=====LAB-LRR: Expected actions=====
-The XIS/LIS (LAB-LRR) SHALL process the response Bundle in accordance with the intentions of the trigger event that caused the retrieve. Actions may include discrete rendering on screen or in context with other information, triggering alerts on trends, ordering of (other) tests and more.
-=Release Notes=
+=====LAB-LRB-PGO: Expected actions=====
-Please note that we have gained new insights based on the developments in HL7 Europe and the HL7 WGM. The necessary changes based on this feedback will be addressed and released in the next release.
+The LIS (LAB-LRB-PGO) SHALL process the response Bundle in accordance with the intentions of the trigger event that caused the retrieve. Actions may include discrete rendering on screen or in context with other information, triggering alerts on trends, ordering of (other) tests and more.