Laboratory Results Profiles

1

Hello:

I’m trying to understand the differences between

http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-diagnosticreport-lab.html

and

http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-observation-lab.html

Both suggest the following uses:

  • Query for lab reports belonging to a Patient
  • [Record or update] a lab report for a specific Patient

The Observation Must Haves are very similar…with slight differences like the 2nd one mentions including the issuer of the report, while the 1st one does not.

Are we expected to include both of these…in the context of the ONC HealthIT (g)(10) Application Access API? They seem fairly duplicative.

We are an Behavioral Health EHR, and our software places Orders, and receives Results back from a 3rd party go-between, who receives them from the individual Labs.

Thanks

2

And follow-up as I think more about this. Would it be acceptable to report the Diagnostic Labs profile as Not Supported and then use the Observation Labs?

I don’t think we are going to support the rest of the DiagnosticReports endpoint…since with Behavioral Health we don’t do things like X-Rays and Cardiac testing.

3

US Core has identified both as required to satisfy the USCDI requirement. The reality is that some reports may only come back as a DiagnosticReport. Others will have Observations but may have information reflected in the DiagnosticReport that isn’t present in the discrete Observations. Typically labs are pretty sensitive about having their ‘report’ view displayed (or at least available) even if the information is present in the discrete observations.

4

Thanks for the reply.

The more I study this, I think I was entirely wrong to begin with.

Lets say a Patient has a CBC Test, which returns 18 different results.

In response to a FHIR request, we would return the following items

  1. A single DiagnosticReport with the Code ect… for a CBC
  2. In the result (which is 0 to many), we would include 18 references to Lab Observations
  3. 18 Lab Observations, one for each Loinc code/result that was returned in the CBC
  4. Optionally, in the DiagnosticReport, we could also return a presentedForm, being the PDF returned from the lab.
5

That’s correct. And it’s appropriate to retain all of them.