English Generated Narrative: StructureDefinition bd-lab-report Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> DiagnosticReport 0..* DiagnosticReport A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports #xD; identifier S 1..* Identifier Business identifier for report #xD; value 1..1 string The value that is unique #xD; status 1..1 code registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required) #xD; category S 1..* CodeableConcept Service category Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0074 #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: LAB #xD; display 1..1 string Representation defined by the system Fixed Value: Laboratory #xD; code S 1..1 CodeableConcept Name/Code for this diagnostic report Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://loinc.org #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 11502-2 #xD; display 1..1 string Representation defined by the system Fixed Value: Laboratory report #xD; subject S 1..1 Reference(Patient) The subject of the report - usually, but not always, the patient #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; display S 1..1 string Text alternative for the resource #xD; encounter S 1..1 Reference(Encounter) Health care event when test ordered #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; Slices for effective[x] S 1..1 dateTime, Period Clinically relevant time/time-period for report Slice: Unordered, Open by type:$this #xD; effective[x]:effectiveDateTime 0..1 dateTime Clinically relevant time/time-period for report #xD; issued S 1..1 instant DateTime this version was made #xD; performer S 1..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service #xD; resultsInterpreter S 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter #xD; specimen S 0..* Reference(Specimen) Specimens this report is based on #xD; result S 1..* Reference(Bangladesh Laboratory Panel Observation | Bangladesh Laboratory Result Observation) Observations #xD; conclusion S 0..1 string Clinical conclusion (interpretation) of test results #xD; conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results #xD; presentedForm S 0..* Attachment Entire report as issued #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format German Generated Narrative: StructureDefinition bd-lab-report Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> DiagnosticReport 0..* DiagnosticReport A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports #xD; identifier S 1..* Identifier Business identifier for report #xD; value 1..1 string The value that is unique #xD; status 1..1 code registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required) #xD; category S 1..* CodeableConcept Service category Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0074 #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: LAB #xD; display 1..1 string Representation defined by the system Fixed Value: Laboratory #xD; code S 1..1 CodeableConcept Name/Code for this diagnostic report Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://loinc.org #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 11502-2 #xD; display 1..1 string Representation defined by the system Fixed Value: Laboratory report #xD; subject S 1..1 Reference(Patient) The subject of the report - usually, but not always, the patient #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; display S 1..1 string Text alternative for the resource #xD; encounter S 1..1 Reference(Encounter) Health care event when test ordered #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; Slices for effective[x] S 1..1 dateTime, Period Clinically relevant time/time-period for report Slice: Unordered, Open by type:$this #xD; Slices for effective[x] Content/Rules for all slices #xD; effective[x]:effectiveDateTime 0..1 dateTime Clinically relevant time/time-period for report #xD; issued S 1..1 instant DateTime this version was made #xD; performer S 1..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service #xD; resultsInterpreter S 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter #xD; specimen S 0..* Reference(Specimen) Specimens this report is based on #xD; result S 1..* Reference(Bangladesh Laboratory Panel Observation | Bangladesh Laboratory Result Observation) Observations #xD; conclusion S 0..1 string Clinical conclusion (interpretation) of test results #xD; conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results #xD; presentedForm S 0..* Attachment Entire report as issued #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format French Narratif généré : DéfinitionStructure bd-lab-report Nom Drapeaux Card. Type Description et contraintes<img src="[binary]" alt="doco" style="background-color: inherit"/> DiagnosticReport 0..* DiagnosticReport A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports #xD; identifier S 1..* Identifier Business identifier for report #xD; value 1..1 string The value that is unique #xD; status 1..1 code registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required) #xD; category S 1..* CodeableConcept Service category Motif requis: Au moins les éléments suivants #xD; coding 1..* Coding Code defined by a terminology system Valeur fixe : (Complexe) #xD; system 1..1 uri Identity of the terminology system Valeur fixe : http://terminology.hl7.org/CodeSystem/v2-0074 #xD; code 1..1 code Symbol in syntax defined by the system Valeur fixe : LAB #xD; display 1..1 string Representation defined by the system Valeur fixe : Laboratory #xD; code S 1..1 CodeableConcept Name/Code for this diagnostic report Motif requis: Au moins les éléments suivants #xD; coding 1..* Coding Code defined by a terminology system Valeur fixe : (Complexe) #xD; system 1..1 uri Identity of the terminology system Valeur fixe : http://loinc.org #xD; code 1..1 code Symbol in syntax defined by the system Valeur fixe : 11502-2 #xD; display 1..1 string Representation defined by the system Valeur fixe : Laboratory report #xD; subject S 1..1 Reference(Patient) The subject of the report - usually, but not always, the patient #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; display S 1..1 string Text alternative for the resource #xD; encounter S 1..1 Reference(Encounter) Health care event when test ordered #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; Slices pour effective[x] S 1..1 dateTime, Period Clinically relevant time/time-period for report Slice: Non ordonné, Ouvert par type:$this #xD; Slices pour effective[x] Contenu/Règles pour toutes les slices #xD; effective[x]:effectiveDateTime 0..1 dateTime Clinically relevant time/time-period for report #xD; issued S 1..1 instant DateTime this version was made #xD; performer S 1..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service #xD; resultsInterpreter S 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter #xD; specimen S 0..* Reference(Specimen) Specimens this report is based on #xD; result S 1..* Reference(Bangladesh Laboratory Panel Observation | Bangladesh Laboratory Result Observation) Observations #xD; conclusion S 0..1 string Clinical conclusion (interpretation) of test results #xD; conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results #xD; presentedForm S 0..* Attachment Entire report as issued #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation pour ce format
Directorate General of Health Services (DGHS), Bangladesh
Profile for laboratory DiagnosticReport in Bangladesh, aligned with IPS (International Patient Summary) DiagnosticReport pattern. Usage: - Represents a complete laboratory report for a patient encounter - DiagnosticReport.result references panel-level Observations (bd-lab-panel-observation) or standalone result Observations (bd-lab-result-observation) where no panel grouping exists - DiagnosticReport.code is fixed to LOINC 11502-2 (Laboratory report) - specimen is SHOULD (MS, 0..*) Report structure: bd-lab-report (DiagnosticReport) ├── result --> bd-lab-panel-observation │ └── hasMember --> bd-lab-result-observation (x N) └── result --> bd-lab-result-observation (standalone, no panel)
A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.
This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Observation[classCode=OBS, moodCode=EVN]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifiers assigned to this report by the performer or other systems.
Usually assigned by the Information System of the diagnostic service provider (filler id).
Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.
OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.
This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.
registered | partial | preliminary | final +
E.g. registered, partial, preliminary, final, amended, corrected
Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"
Fixed to 'LAB' for laboratory diagnostic reports
Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.
inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
Fixed to LOINC 11502-2 — Laboratory report
OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)
The subject of the report - usually, but not always, the patient
Reference to the Patient this report is about
PID-3 (no HL7 v2 mapping for Group or Device)
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Reference to the Encounter during which this report was ordered
This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
Links the request to the Encounter context.
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Clinically relevant time/time-period for report
The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.
If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.
Need to know where in the patient history to file/present this report.
Date/time the specimen was collected or the report period
Date/time the report was issued by the laboratory
May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.
Clinicians need to be able to check the date that the report was released.
Laboratory or practitioner who performed the test
Typically the laboratory Organization. May also include the responsible Practitioner.
Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.
PRT-8 (where this PRT-4-Participation = "PO")
Clinician or pathologist who interpreted the laboratory results
Include when a formal interpretation or authorisation was made by a named clinician.
OBR-32, PRT-8 (where this PRT-4-Participation = "PI")
Specimen(s) used for this laboratory report
Should be present when specimen information is available. IPS alignment: SHOULD.
Need to be able to report information about the collected specimens on which the report is based.
References to Observation resources that are part of this report
Use BDLabPanelObservationProfile for ordered panels (CBC, LFT, RFT, etc.) where individual results are grouped under a panel using hasMember. Use BDLabResultObservationProfile directly for standalone results that are not part of a named panel.
Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.
Reference to full details of imaging associated with the diagnostic report
One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.
ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.
outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]
A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).
Many diagnostic services include images in the report as part of their service.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Comment about the image (e.g. explanation)
A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.
The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.
The provider of the report should make a comment about each image included in the report.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
Clinical conclusion (interpretation) of test results
Clinical interpretation or summary of the laboratory report
Need to be able to provide a conclusion that is not lost among the basic result data.
inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
Codes for the clinical conclusion of test results
Coded representation of the clinical conclusion
May use ICD-11 MMS codes consistent with bd-condition-icd11-diagnosis-valueset
Diagnosis codes provided as adjuncts to the report.
inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
Entire report as issued — e.g. PDF attachment
Include the original report document when available
Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.