L2z:v4.0.0 FHIR lab2zorg: verschil tussen versies

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Regel 1: Regel 1:
 
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{{DISPLAYTITLE: Technical Design Lab2zorg V4.0.0-beta.1}}
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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.''  
 
''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.''  
Regel 8: Regel 8:
 
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<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:v4.0.0_ontwerp_lab2zorg|Functional]]
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circle 990 216 215 [[Lab:V3.0.0-B4_FHIR_Lab2zorg|Technical]]
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circle 990 216 215 [[L2z:v4.0.0_FHIR_lab2zorg|Technical]]
 
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<big>For an overview of all current documentation [[Lab:V3.0.0_Ontwerp_Laboverdacht| see information standard lab exchange main page]]</big>
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<big>For an overview of all current documentation [[Landingspagina_Labuitwisseling| see information standard lab exchange main page]]</big>
  
 
__NUMBEREDHEADINGS__
 
__NUMBEREDHEADINGS__
  
 
==Introduction==
 
==Introduction==
−
[[Bestand:Functioneel-02.png|link=Lab:V3.0.0-b4_Ontwerp_Lab2zorg|100px|rechts|Functional design|Go to functional design]]
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[[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 [[Lab:V3.0.0-b4_Ontwerp_Lab2zorg| functional design Lab2zorg 3.0.0-beta.4]]. The data exchange format used in this version is: FHIR R4.
+
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 ===
 
=== Support ===
Regel 25: Regel 25:
  
 
=== Boundaries ===
 
=== 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 [[Lab:V3.0.0-b4_Ontwerp_Lab2zorg| functional design Lab2zorg 3.0.0-beta.4]].
+
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 ===
 
=== Prerequisite knowledge ===
 
The following background information is required for understanding this TO:
 
The following background information is required for understanding this TO:
−
* The [[Lab:V3.0.0-b4_Ontwerp_Lab2zorg| functional design Lab2zorg 3.0.0-beta.4]] accompanying 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:
 
* 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|general FHIR R4 Implementation Guide]],
Regel 147: Regel 147:
 
|}
 
|}
  
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==== Search parameters ====
+
==== FHIR Search parameters ====
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{| style="text-align: left;" cellpadding=5px;  
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The search interaction is performed by an HTTP GET in agreement with the [http://hl7.org/fhir/R4/search.html FHIR specification]. The table below lists search parameters for Observation resource that SHALL be supported for processing by servers and clients.
 +
 
 +
{| style="text-align: left; width: 100%" cellpadding=5px;  
 
|- style="color: white; background-color: #e7844b;"
 
|- style="color: white; background-color: #e7844b;"
−
! FHIR Search Parameter || Description || FHIR Resource || Example
+
! Variation type || Variation || Permitted values (if limited) || Data type || Description
  
 
|- style="color: white; background-color: #eda778;"
 
|- style="color: white; background-color: #eda778;"
−
! colspan="5"  | Retrieve laboratory results (Observation search)
+
! colspan="5"  | category
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
−
| category || Restrict search to laboratory observations || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory</pre>
+
| || || {{fhir|<nowiki>https://terminology.hl7.org/CodeSystem/observation-category|laboratory</nowiki>}} || {{fhir|token}} || Search on laboratory observations.
 +
 
 +
|- style="color: white; background-color: #eda778;"
 +
! colspan="5"  | patient
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
−
| patient (with modifier identifier) || Constrain results to a specific patient context || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333</pre>
+
| modifier || {{fhir|identifier}} || {{fhir|<nowiki>http://fhir.nl/fhir/NamingSystem/bsn|[BSN]</nowiki>}} || {{fhir|token}} || Search in a specific patient context
 +
 
 +
|- style="color: white; background-color: #eda778;"
 +
! colspan="5"  | code
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
−
| code || Filter by laboratory test code (LOINC/NHG) || Observation || <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>
+
| code system || LOINC || {{fhir|<nowiki>http://loinc.org|[test code]</nowiki>}} || {{fhir|token}} || Search on the LOINC test code
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
−
| date || Filter results based on observation date || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&date=gt2022-03-12&date=lt2022-06-07</pre>
+
| code system || NHG || {{fhir|<nowiki>https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|[test code]</nowiki>}} || {{fhir|token}} || Search on the NHG test code
  
 
|- style="color: white; background-color: #eda778;"
 
|- style="color: white; background-color: #eda778;"
−
! colspan="5" | Retrieve latest laboratory results ($lastn operation)
+
! colspan="5" | date
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
−
| $lastn (max=1 is default) || Retrieve most recent lab result using the $lastn operation || Observation || <pre>GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7</pre>
+
| prefix || {{fhir|gt}} || || {{fhir|date}} || Search on observation date later than the value
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
−
| max || Retrieve 5 most recent lab results using the $lastn operation || Observation || <pre>GET [base]/Observation/$lastn?max=5&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7</pre>
+
| prefix || {{fhir|lt}} || || {{fhir|date}} || Search on observation date earlier than the value
  
 
|- style="color: white; background-color: #eda778;"
 
|- style="color: white; background-color: #eda778;"
−
! colspan="5" | Retrieve related resources
+
! colspan="5" | _include
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
−
| _include || Include linked resources (Specimen, Patient, Organization) in the response bundle || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&_include=Observation:specimen&_include=Observation:patient&_include=Observation:performer</pre>
+
| modifier || {{fhir|iterate}} || || {{fhir|reference}} || Include linked resources iteratively
 +
 
 +
|- style="background-color: #fcf0e9;"
 +
| resource || {{fhir|Patient}} || {{fhir|Observation:patient}} || {{fhir|reference}} || Include linked Patient resources in the response bundle
 +
 
 +
|- style="background-color: #fcf0e9;"
 +
| resource || {{fhir|Organization}} || {{fhir|Observation:organization}} || {{fhir|reference}} || Include linked Organization resources in the response bundle
 +
 
 +
|- style="background-color: #fcf0e9;"
 +
| resource || {{fhir|Specimen}} || {{fhir|Observation:specimen}} || {{fhir|reference}} || Include linked Specimen resources in the response bundle
 +
 
 +
|+ style="align: bottom; caption-side: bottom; text-align: left;" |  
 +
|}
 +
 
 +
For the Observation search, the parameters {{fhir|category}} and {{fhir|patient:identifier}} SHALL be included within every search request. The parameters {{fhir|code}}, {{fhir|_include}}, and {{fhir|_include:iterate}} can be repeated; {{fhir|code}} supports combination with AND or OR, while {{fhir|_include}} and {{fhir|_include:iterate}} support combination with AND only. In FHIR search, OR logic is used when multiple values are supplied for the same search parameter (comma-separated), meaning a resource matches if any of the values apply. AND logic is used when a search parameter is to be repeated, meaning the resource must satisfy all of the specified conditions.
 +
 
 +
==== 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;" |  
 
|+ style="align: bottom; caption-side: bottom; text-align: left;" |  
Regel 201: Regel 275:
 
|+ style="align: bottom; caption-side: bottom; text-align: left;" | ''Abbreviations: LAB = Laboratorium, LRS = Laboratoriumresultaat sturend (systeem), LRO = Laboratoriumresultaat ontvangend (systeem).''
 
|+ 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.

Huidige versie van 4 jun 2026 om 15:44


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.

Issue icon.png 

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.
FunctionalTechnicalFunctioneel-Technisch

For an overview of all current documentation see information standard lab exchange main page


1 Introduction

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 functional design Lab2zorg. The data exchange format used in this version is: FHIR R4.

1.1 Support

For questions, feedback, or change requests, please contact our support team at Nictiz Servicemanagement.

1.2 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 functional design Lab2zorg.

1.3 Prerequisite knowledge

The following background information is required for understanding this TO:

2 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.

2.1 Model overview for usecases without the request

FHIR-model-overview-L2Z-SLR-BLR.png

2.2 Model overview for usecase with the request

FHIR-model-overview-L2P-LOA.png

3 Components

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

3.1 HL7 FHIR R4

Em.png

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:

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.

3.1.1 Artifacts

The artifacts of the information standard are presented in the following table:

zib FHIR resource FHIR profile
HealthcareProvider Organization nl-core-HealthcareProvider-Organization
HealthProfessional Practitioner nl-core-HealthProfessional-Practitioner
PractitionerRole nl-core-HealthProfessional-PractitionerRole
LaboratoryTestResult Device nl-core-LaboratoryTestResult.Specimen.Source
Observation nl-core-LaboratoryTestResult
Specimen nl-core-LaboratoryTestResult.Specimen
Patient Patient nl-core-Patient
DiagnosticReport lu-LaboratoryTestResult-DiagnosticReport
ServiceRequest lu-OrderData

3.1.2 Examples of FHIR instances

You can find examples of FHIR-instances (filled-in FHIR profiles) in the Nictiz GitHub repository: Lab exchange HL7-mappings repository.

4 Transactions

4.1 Health professional orders lab tests and receives results

4.1.1 Involved actors

Transaction group Transaction Actor System role code FHIR CapabilityStatement
Send laboratory results based on a request Send laboratory results based on a request Client LAB-LAS Lab2Healthcare_Results_SendReceive
Receive laboratory results Server LAB-LAO
Abbreviations: LAB = Laboratorium, LAS = Laboratoriumresultaat antwoord sturend (systeem), LAO = Laboratoriumresultaat antwoord ontvangend (systeem).

4.2 Health professional retrieves lab results

4.2.1 Involved actors

Transaction group Transaction Actor System role code FHIR CapabilityStatement
Retrieve laboratory results (PULL) Retrieve laboratory results request Client LAB-LRR Lab2Healthcare_Results_RetrieveServe
Retrieve laboratory results response Server LAB-LRB
Abbreviations: LAB = Laboratorium, LRR = Laboratoriumresultaat raadplegend (systeem), LRB = Laboratoriumresultaat beschikbaarstellend (systeem).

4.2.2 FHIR Search parameters

The search interaction is performed by an HTTP GET in agreement with the FHIR specification. The table below lists search parameters for Observation resource that SHALL be supported for processing by servers and clients.

Variation type Variation Permitted values (if limited) Data type Description
category
https://terminology.hl7.org/CodeSystem/observation-category|laboratory token Search on laboratory observations.
patient
modifier identifier http://fhir.nl/fhir/NamingSystem/bsn|[BSN] token Search in a specific patient context
code
code system LOINC http://loinc.org|[test code] token Search on the LOINC test code
code system NHG https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|[test code] token Search on the NHG test code
date
prefix gt date Search on observation date later than the value
prefix lt date Search on observation date earlier than the value
_include
modifier iterate reference Include linked resources iteratively
resource Patient Observation:patient reference Include linked Patient resources in the response bundle
resource Organization Observation:organization reference Include linked Organization resources in the response bundle
resource Specimen Observation:specimen reference Include linked Specimen resources in the response bundle

For the Observation search, the parameters category and patient:identifier SHALL be included within every search request. The parameters code, _include, and _include:iterate can be repeated; code supports combination with AND or OR, while _include and _include:iterate support combination with AND only. In FHIR search, OR logic is used when multiple values are supplied for the same search parameter (comma-separated), meaning a resource matches if any of the values apply. AND logic is used when a search parameter is to be repeated, meaning the resource must satisfy all of the specified conditions.

4.2.3 FHIR Operations

Clients may invoke $lastn to retrieve the most recent Observation(s). The parameter max can optionally be provided to specify the number of observations to be returned. For more information on $lastn, consult $lastn operation.

4.2.4 FHIR Search examples

Examples
Show all laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333 
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
Show all laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333 from 12 March 2022 
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
Show all laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333 between 12 March 2022 and 7 June 2022 
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
Show all laboratory results with test code 14683-7 (LOINC) or 3583 (NHG) of the patient with BSN 111222333 
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
Show the most recent laboratory result with test code 14683-7 (LOINC) of the patient with BSN 111222333 
GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&code=http://loinc.org|14683-7
Show the five most recent laboratory results with test code 14683-7 (LOINC) of the patient with BSN 111222333 
GET [base]/Observation/$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
Show the most recent laboratory result of the patient with BSN 111222333 
GET [base]/Observation/$lastn?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&patient:identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333

4.3 Health professional sends lab results to other health professional

4.3.1 Involved actors

Transaction group Transaction Actor System role code FHIR CapabilityStatement
Send laboratory results (PUSH) Send laboratory results Client LAB-LRS Lab2Healthcare_Results_SendReceive
Receive laboratory results Server LAB-LRO
Abbreviations: LAB = Laboratorium, LRS = Laboratoriumresultaat sturend (systeem), LRO = Laboratoriumresultaat ontvangend (systeem).

5 Additional guidance

5.1 Translations

When multiple codings are used for the same laboratory test, they should be represented as translations of the same concept within one CodeableConcept (FHIR specification). This means that the codes do not represent different test results. Instead, they are alternative codes for the same laboratory test.

Observation.code may contain multiple coding elements: 

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

The following code systems may be used:

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.

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