L2p:V2 FHIR lab2patient

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 FHIR resource used for the use case 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.

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

1 Introduction

This is the technical design (TO) for the information standard (IS) Lab2patient. This TO must be used together with the IS functional design, see functional design Lab2patient 1.0.0-beta.2. 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 Lab2patient 1.0.0-beta.2.

1.3 Prerequisite knowledge

The following background information is required for understanding this TO:

• The functional design Lab2patient 1.0.0-beta.2 accompanying this TO.
• The data exchange format FHIR R4, which you can find here:
  • general FHIR R4 Implementation Guide,
  • FHIR packages,
  • usage of the .id, .identifier and .fullUrl.

2 Relationships

The diagram below shows 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.

3 Components

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

3.1 HL7 FHIR R4

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 4.0.0-beta.2 or compatible nictiz.fhir.nl.r4.nl-core version 0.12.0-labtrial.1 or compatible nictiz.fhir.nl.r4.zib2020 version 0.12.0-labtrial.1 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.

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 Patient retrieves laboratory results in their PGO

4.1.1 Involved actors

Abbreviations: LAB = Laboratorium, LRR = Laboratoriumresultaat raadplegend (systeem), LRB = Laboratoriumresultaat beschikbaarstellend (systeem), PGO = Persoonlijke gezondheidsomgeving.

Transaction group	Transaction	Actor	System role code	FHIR CapabilityStatement
Retrieve laboratory results (PULL)	Retrieve laboratory results request	Client	LAB-LRR-PGO	Lab2Patient_Results_RetrieveServe
	Retrieve laboratory results response	Server	LAB-LRB-PGO

4.1.2 FHIR Search parameters

The search interaction is performed by an HTTP GET in agreement with the 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.

1. = 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: /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 DiagnosticReport resource.

Name	#	Value #	Type	Description
result.category	1..1	1..1	token	Search DiagnosticReports that reference laboratory observations. Fixed value: https://terminology.hl7.org/CodeSystem/observation-category|laboratory
result.code	0..*	1..*	token	Limit results to DiagnosticReports with observations containing a LOINC or an NHG test code. http://loinc.org|[test code], https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|[test code]
result.date	0..2	1..1	date	Search on DiagnosticReports including observations with date earlier or later than the value. To be used with prefixes lt or gt.
_include	0..*	1..1	reference	Include linked resource, can be used in conjunction with modifier iterate which includes resources iteratively.

4.1.3 Chaining parameters

Chained search parameters are used to apply criteria to resources referenced by DiagnosticReport. In this use case, Observation criteria are applied through DiagnosticReport.result, for example by using result.code, result.category, and result.date to search for reports that reference matching Observations. For more information on chaining, consult FHIR specification.

4.1.4 Most recent functionality

To retrieve the most recent reports, clients SHALL use the regular FHIR search interaction on DiagnosticReport in combination with sorting and paging parameters. The parameter _sort with value -date is used to sort reports by date in descending order. The parameter _count can be used to limit the number of DiagnosticReport resources returned.

4.1.5 FHIR Search examples

Examples
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC)
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_include=DiagnosticReport:result
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) from 12 March 2022
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&result.date=gt2022-03-12&_include=DiagnosticReport:result
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) between 12 March 2022 and 7 June 2022
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&result.date=gt2022-03-12&result.date=lt2022-06-07&_include=DiagnosticReport:result
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) or 3583 (NHG)
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7,https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|3583&_include=DiagnosticReport:result
Show the most recent DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC)
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_sort=-date&_count=1&_include=DiagnosticReport:result
Show the five most recent DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC)
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_sort=-date&_count=5&_include=DiagnosticReport:result