Order Catalog Implementation Guide
current - CI Build

Order Catalog Implementation Guide, published by HL7 International - Orders and Observations Work Group. This is not an authorized publication; it is the continuous build for version current). This version is based on the current content of https://github.com/HL7/fhir-order-catalog/ and changes regularly. See the Directory of published versions

Examples - Laboratory services

This section presents the examples of catalogs of laboratory diagnostic services. Rather than showing full details of the resources built, each example focuses on the key elements illustrating the FHIR design of laboratory catalogs. The full details for each resource built can be viewed in the Artifact Index in the example section.

The examples are indexed E1, E2, E3, ...

E1: Blood potassium test

This example illustrates the representation of a simple diagnostic test in the laboratory compendium. The figure below displays the business content.

Example E1 - business content

The figure below displays the FHIR technical implementation of the business content.

Example E1 - FHIR implementation

The laboratory service is of type "test". A single test produces usually a single measurement. As shown in this example, the notion of orderability is represented by a predefined context of use: "service associated with laboratory order entry task". A service is orderable if and only if the PlanDefinition representing it includes a useContext element with code = "task" and valueCodeableConcept = "LABOE" (laboratory order entry task) from the V3 ActCode vocabulary.

Artifacts implementing this example:

Business content Base resource Profile Example artifact
Laboratory compendium Composition CatalogHeader example-lab-compendium-header
Serum potassium - orderable service PlanDefinition LabServiceDefinition example-lab-service-potassium-serum
Serum potassium - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-potassium-serum
Serum specimen SpecimenDefinition LabSpecimenDefinition example-specimen-venous-serum-single-test
Reason for test - input observation ObservationDefinition InputObservationDefinition example-input-observation-reason-for-ordering
K serum level - test result ObservationDefinition LabObservationDefinition example-observation-serum-potassium

E2: Blood electrolyte

This example illustrates the representation of a panel of tests in the laboratory compendium. The figure below displays the business content.

Example E2 - business content

The figure below displays the FHIR technical implementation of the business content.

Example E2 - FHIR implementation

The electrolyte panel E2 includes K on serum also orderable as a single test in example E1. The PlanDefinition references a single electrolyte ActivityDefinition, which references the ObservationDefinition representing the single test from example E1. The PlanDefinition of E2 also includes the PlanDefinition from E1 as related artifact, for informative purpose.

In this example, the laboratory service is of type "panel". A panel is a collection of test of panels, which usually produces multiple results.

Artifacts implementing this example:

Business content Base resource Profile Example artifact
Laboratory compendium Composition CatalogHeader example-lab-compendium-header
Blood electrolyte panel - orderable service PlanDefinition LabServiceDefinition example-lab-panel-blood-electrolyte
Serum potassium test - orderable service PlanDefinition LabServiceDefinition example-lab-service-potassium-serum
Blood electrolyte panel - operational procedure ActivityDefinition LabProcedureDefinition example-lab-blood-electrolyte
Serum or plasma specimen SpecimenDefinition LabSpecimenDefinition example-specimen-serum-plasma
Reason for test - input observation ObservationDefinition InputObservationDefinition example-input-observation-reason-for-ordering
Na serum level - test result ObservationDefinition LabObservationDefinition example-observation-serum-sodium
K serum level - test result ObservationDefinition LabObservationDefinition example-observation-serum-potassium
Cl serum level - test result ObservationDefinition LabObservationDefinition example-observation-serum-chloride

E3: creatinine on 24H urine

This example illustrates the representation of a panel of tests in the laboratory compendium, using some observations both as input and output. The figure below displays the business content.

Example E3 - business content

The figure below displays the FHIR technical implementation of the business content.

Example E3 - FHIR implementation

In this example, the laboratory service is of type "panel". A panel is a collection of test of panels, which usually produces multiple results. The observations "24h urine volume" and "urine collection duration" are used both as input (proved by the specimen collector) and as results of the panel.

Artifacts implementing this example:

Business content Base resource Profile Example artifact
Laboratory compendium Composition CatalogHeader example-lab-compendium-header
24-hour urine creatinine panel - orderable service PlanDefinition LabServiceDefinition example-lab-panel-urine24h-creatinine
24-hour urine creatinine panel - operational procedure ActivityDefinition LabProcedureDefinition example-lab-urine24h-creatinine
24-hour urine specimen SpecimenDefinition LabSpecimenDefinition example-specimen-urine-24h
urine collection duration - input/output observation ObservationDefinition InputObservationDefinition example-observation-collection-duration
LabObservationDefinition
24-hour urine volume - input/output observation ObservationDefinition InputObservationDefinition example-observation-collection-volume
LabObservationDefinition
24-hour urine creatinine - lab result ObservationDefinition LabObservationDefinition example-observation-urine24h-creatinine

E4: creatinine on serum or plasma

This example illustrates the representation of a laboratory service using two alternative kinds of specimens. The figure below displays the business content.

Example E4 - business content

The figure below displays the FHIR technical implementation of the business content.

Example E4 - FHIR implementation

In this example, the laboratory service is of type "test" and is expected to produce an single result; the serum/plasma creatinine level. The service is operationalized by two alternative procedures (ActivityDefinition) depending of the kind of specimen collected. Both procedures produce the same observation "serum creatinine"

Artifacts implementing this example:

Business content Base resource Profile Example artifact
Laboratory compendium Composition CatalogHeader example-lab-compendium-header
serum/plasma creatinine - orderable service PlanDefinition LabServiceDefinition example-lab-test-serum-creatinine
serum/plasma creatinine operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-serum-creatinine
capillary blood serum/plasma specimen SpecimenDefinition LabSpecimenDefinition example-specimen-capillary-serum-single-test
venous blood serum/plasma specimen SpecimenDefinition LabSpecimenDefinition example-specimen-venous-serum-single-test
serum/plasma creatinine - lab result ObservationDefinition LabObservationDefinition example-observation-serum-creatinine

E5: creatinine renal clearance

This example illustrates how a panel can logically include a combination of tests and panels, using logical AND and XOR to assemble them. The figure below displays the business content.

Example E5 - business content

The figure below displays the FHIR technical implementation of the business content.

Example E5 - FHIR implementation

In this example, the laboratory service is of type "panel" it assembles two other panels and one single test.

Artifacts implementing this example:

Business content Base resource Profile Example artifact
Laboratory compendium Composition CatalogHeader example-lab-compendium-header
creatinine renal clearance - orderable service PlanDefinition LabServiceDefinition example-lab-panel-urine24h-creatinine-clearance
serum/plasma creatinine operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-serum-creatinine
capillary blood serum/plasma specimen SpecimenDefinition LabSpecimenDefinition example-specimen-capillary-serum-single-test
venous blood serum/plasma specimen SpecimenDefinition LabSpecimenDefinition example-specimen-venous-serum-single-test
serum/plasma creatinine - lab result ObservationDefinition LabObservationDefinition example-observation-serum-creatinine
24-hour urine creatinine panel - operational procedure ActivityDefinition LabProcedureDefinition example-lab-urine24h-creatinine
24-hour urine specimen SpecimenDefinition LabSpecimenDefinition example-specimen-urine-24h
urine collection duration - input/output observation ObservationDefinition InputObservationDefinition example-observation-collection-duration
LabObservationDefinition
24-hour urine volume - input/output observation ObservationDefinition InputObservationDefinition example-observation-collection-volume
LabObservationDefinition
24-hour urine creatinine - lab result ObservationDefinition LabObservationDefinition example-observation-urine24h-creatinine
24-hour urine creatinine clearance - operational procedure ActivityDefinition LabProcedureDefinition example-lab-urine24h-creatinine-clearance
creatinine renal clearance - lab result ObservationDefinition LabObservationDefinition example-observation-creatinine-renal-clearance

E6: Vitamin D

This example illustrates the representation of a simple diagnostic test in the laboratory compendium, associated with a billing code and billing rules. The example is in French as is the billing coding system.

The figure below displays the business content.

Example E6 - business content

The figure below displays the FHIR technical implementation of the business content.

Example E6 - FHIR implementation

The laboratory service is of type "test". A single test produces usually a single measurement. This service can be claimed for reimbursement only if it is ordered with a clinical context that matches one of the clinical focuses declared in the ChargeItemDefinition referenced by the service.

Artifacts implementing this example:

Business content Base resource Profile Example artifact
Laboratory compendium Composition CatalogHeader example-lab-compendium-header
Vitamin D - orderable service PlanDefinition LabServiceDefinition example-lab-service-vitamind-serum
Vitamin D - billing code and conditions ChargeItemDefinition LabChargeItemDefinition example-lab-billing-vitamind-focus
Vitamin D - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-vitamind-serum
Serum specimen SpecimenDefinition LabSpecimenDefinition example-specimen-venous-serum-single-test
Clinical contexts for test - input observation ObservationDefinition InputObservationDefinition example-input-observation-context-for-vitamin-d
Normal Contexts for Vitamin D Test ValueSet example-normal-contexts-vitamin-d
All contexts possibly associated with Vitamin D Test ValueSet example-clinical-focus
Vitamin D level - test result ObservationDefinition LabObservationDefinition example-observation-vitamin-d

E7: TORCH super-panel

This example illustrates the representation of a super-panel embedding two single tests orderable individually and two sub-panels also orderable individually, one of which embeds two reflex tests (also orderable themselves).

The 2 figures below show the business content of the HSV sub-panel having the two reflex tests, and then its FHIR resource representation.

Example E7 - business content (part 1) Example E7 - FHIR implementation (part 1)

The 2 figures below show the TORCH super-panel, which embeds the HSV sub-panel above. Business content, and then FHIR resource representation:

Example E7 - business content (part 2) Example E7 - FHIR implementation (part 2a) Example E7 - FHIR implementation (part 2b)

The TORCH laboratory service is of type "panel".

All directly embedded panels and tests are referenced as related artifacts: PlanDefinition.relatedArtifact:Includes (type = composed-of).

Reflex tests are represented as sub-actions grouped in a logical group with behavior "any" meaning that any number of members of the group may be performed. Each sub-action is associated with a trigger conveying the named event, which reflexes it.

Artifacts implementing this example:

Business content Base resource Profile Example artifact
Laboratory compendium Composition CatalogHeader example-lab-compendium-header
TORCH super-panel - orderable service PlanDefinition LabServiceDefinition example-lab-service-torch
Toxoplasma Ab panel - orderable service PlanDefinition LabServiceDefinition example-lab-service-toxoplasma-serum
Rubella IgM panel - orderable service PlanDefinition LabServiceDefinition example-lab-service-rubella-serum
Cytomegalovirus IgM panel - orderable service PlanDefinition LabServiceDefinition example-lab-service-cmv-serum
Herpes simplex virus 1 & 2 IgM panel - orderable service PlanDefinition LabServiceDefinition example-lab-service-hsv-serum
Herpes simplex virus 1 IgM Titer - as orderable test PlanDefinition LabServiceDefinition example-lab-service-hsvt1-serum
Herpes simplex virus 2 IgM Titer - as orderable test PlanDefinition LabServiceDefinition example-lab-service-hsvt2-serum
3 mL serum specimen SpecimenDefinition LabSpecimenDefinition example-specimen-3ml-serum
2 mL serum specimen SpecimenDefinition LabSpecimenDefinition example-specimen-2ml-serum
Toxoplasma Ab - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-toxoplasma
Rubella IgM - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-rubella
CMV IgM - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-cmv
HSV 1 & 2 IgM - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-hsv
HSV 1 IgM Titer - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-hsvt1
HSV 2 IgM Titer - operational procedure ActivityDefinition LabProcedureDefinition example-lab-procedure-hsvt2
Toxoplasma IgG test result ObservationDefinition LabObservationDefinition example-observation-toxoigg
Toxoplasma IgM test result ObservationDefinition LabObservationDefinition example-observation-toxoigm
Toxoplasma Antibody interpretation ObservationDefinition LabObservationDefinition example-observation-toxoint
Rubella IgM test result ObservationDefinition LabObservationDefinition example-observation-rubigm
CMV IgM test result ObservationDefinition LabObservationDefinition example-observation-cmvigm
HSV 1 IgM presence test result ObservationDefinition LabObservationDefinition example-observation-hsv1igmp
HSV 2 IgM presence test result ObservationDefinition LabObservationDefinition example-observation-hsv2igmp
HSV 1 IgM titer result ObservationDefinition LabObservationDefinition example-observation-hsv1igmt
HSV 2 IgM titer result ObservationDefinition LabObservationDefinition example-observation-hsv2igmt