Technical Design Lab2patient v2.0.0-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 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:
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:
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
| Transaction group | Transaction | Actor | System role code |
|---|---|---|---|
| Retrieve laboratory results (PULL) | Retrieve laboratory results request | Client | LAB-LRR-PGO |
| 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. The table below lists search parameters for DiagnosticReport resource that SHALL be supported for processing by servers and clients.
| Variation type | Variation | Permitted values (if limited) | Data type | Description |
|---|---|---|---|---|
| result.category | ||||
https://terminology.hl7.org/CodeSystem/observation-category|laboratory |
token |
Search DiagnosticReports that reference laboratory Observations. | ||
| result.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 |
| result.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 |
DiagnosticReport:subject |
reference |
Include linked Patient resources in the response bundle. |
| resource | Organization |
DiagnosticReport:performer |
reference |
Include linked Organization resources in the response bundle, when the performer reference points to an Organization. |
| resource | Specimen |
DiagnosticReport:specimen |
reference |
Include linked Specimen resources in the response bundle. |
| resource | Observation |
DiagnosticReport:result |
reference |
Include linked Observation resources in the response bundle. |
| resource | ServiceRequest |
DiagnosticReport:basedOn |
reference |
Include linked ServiceRequest resources in the response bundle. |
For the DiagnosticReport search, the parameters result.category SHALL be included within every search request. The parameters result.code, _include, and _include:iterate can be repeated; result.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.
4.1.3 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 |
