QI-Core Implementation Guide
4.1.0 - release

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## Resource Profile: QICoreDiagnosticReportNote - Detailed Descriptions

Definitions for the qicore-diagnosticreport-note resource profile.

1. DiagnosticReport
Definition | The US Core Diagnostic Report Profile for Report and Note exchange is based upon the requirements of the Argonauts to exchang imaginge reports.
Control | 0..*
Alternate Names | Report, Test, Result, Results, Labs, Laboratory, Imaging Report, Radiology Report
Comments | 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.
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: 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()) dom-4: 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()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.`div`.exists())
2. DiagnosticReport.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | string
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
3. DiagnosticReport.meta
Definition | 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.
Control | 0..1
Type | Meta
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. DiagnosticReport.implicitRules
Definition | 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.
Control | 0..1
Type | uri
Is Modifier | true
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. DiagnosticReport.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages A human language.
Type | code
Comments | 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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. DiagnosticReport.text
Definition | 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.
Control | 0..1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. DiagnosticReport.contained
Definition | 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.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
Comments | 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.
8. DiagnosticReport.extension
Definition | An Extension
Control | 0..*
Type | Extension
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Slicing | This element introduces a set of slices on DiagnosticReport.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
9. DiagnosticReport.extension:locationPerformed
SliceName | locationPerformed
Definition | Facility location where this report was prepared.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(locationPerformed) (Extension Type: Reference(Location))
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. DiagnosticReport.extension:locationPerformed.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
11. DiagnosticReport.extension:locationPerformed.extension
Definition | An Extension
Control | 0..0
Type | Extension
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Slicing | This element introduces a set of slices on DiagnosticReport.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
12. DiagnosticReport.extension:locationPerformed.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Control | 1..1
Type | uri
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value | http://hl7.org/fhir/StructureDefinition/diagnosticReport-locationPerformed
13. DiagnosticReport.extension:locationPerformed.value[x]:valueReference
SliceName | valueReference
Definition | Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Control | 1..1
Type | Reference(QICoreLocation)
[x] Note | See Choice of Data Types for further information about how to use [x]
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. DiagnosticReport.modifierExtension
Definition | 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).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | 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.
Alternate Names | extensions, user content
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
15. DiagnosticReport.identifier
Definition | Identifiers assigned to this report by the performer or other systems.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Requirements | 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.
Alternate Names | ReportID, Filler ID, Placer ID
Comments | Usually assigned by the Information System of the diagnostic service provider (filler id).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. DiagnosticReport.basedOn
Definition | Details concerning a service requested.
Control | 0..*
Type | Reference(CarePlan | QICoreImmunizationRecommendation | QICoreMedicationRequest | NutritionOrder | QICoreServiceRequest)
Requirements | This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.
Alternate Names | Request
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. DiagnosticReport.status
Definition | The status of the diagnostic report.
Control | 1..1
Binding | The codes SHALL be taken from DiagnosticReportStatus
Type | code
Is Modifier | true
Must Support | true
Requirements | Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. DiagnosticReport.category
Definition | A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
Control | 1..*
Binding | The codes SHALL be taken from US Core DiagnosticReport Category; other codes may be used where these codes are not suitable
Type | CodeableConcept
Must Support | true
Alternate Names | Department, Sub-department, Service, Discipline, service, discipline
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. DiagnosticReport.code
Definition | The test, panel, report, or note that was ordered.
Control | 1..1
Binding | The codes SHALL be taken from US Core Diagnosticreport Report And Note Codes; other codes may be used where these codes are not suitable LOINC codes
Type | CodeableConcept
Must Support | true
Alternate Names | Type
Comments | UsageNote= The typical patterns for codes are: 1) a LOINC code either as a translation from a "local" code or as a primary code, or 2) a local code only if no suitable LOINC exists, or 3) both the local and the LOINC translation. Systems SHALL be capable of sending the local code if one exists.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. DiagnosticReport.subject
Definition | The subject of the report. Usually, but not always, this is a patient. However diagnostic services also perform analyses on specimens collected from a variety of other sources.
Control | 1..1
Type | Reference(QICorePatient)
Must Support | true
Requirements | SHALL know the subject context.
Alternate Names | Patient
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. DiagnosticReport.encounter
Definition | The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.
Control | 0..1
Type | Reference(QICoreEncounter)
Must Support | true
Requirements | Links the request to the Encounter context.
Alternate Names | Context
Comments | 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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. DiagnosticReport.effective[x]
Definition | This is the Datetime or Period when the report or note was written.
Control | 1..1
Type | Choice of: dateTime, Period
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Requirements | Need to know where in the patient history to file/present this report.
Alternate Names | Observation time, Effective Time, Occurrence
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. DiagnosticReport.issued
Definition | The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.
Control | 0..1
Type | instant
Must Support | true
Requirements | Clinicians need to be able to check the date that the report was released.
Alternate Names | Date published, Date Issued, Date Verified
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. DiagnosticReport.performer
Definition | The diagnostic service that is responsible for issuing the report.
Control | 0..*
Type | Reference(QICorePractitioner | QICoreOrganization)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Requirements | 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.
Alternate Names | Laboratory, Service, Practitioner, Department, Company, Authorized by, Director
Comments | This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. DiagnosticReport.resultsInterpreter
Definition | The practitioner or organization that is responsible for the report's conclusions and interpretations.
Control | 0..*
Type | Reference(Practitioner | PractitionerRole | Organization | CareTeam)
Requirements | 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.
Alternate Names | Analyzed by, Reported by
Comments | Might not be the same entity that takes responsibility for the clinical report.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. DiagnosticReport.specimen
Definition | Details about the specimens on which this diagnostic report is based.
Control | 0..*
Type | Reference(QICoreSpecimen)
Requirements | Need to be able to report information about the collected specimens on which the report is based.
Comments | If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. DiagnosticReport.result
Definition | Observations that are part of this diagnostic report.
Control | 0..*
Type | Reference(QICoreObservation)
Must Support | true
Requirements | Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.
Alternate Names | Data, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
Comments | Observations can contain observations.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
28. DiagnosticReport.imagingStudy
Definition | 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.
Control | 0..*
Type | Reference(QICoreImagingStudy)
Must Support | true
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. DiagnosticReport.media
Definition | 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).
Control | 0..*
Type | BackboneElement
Requirements | Many diagnostic services include images in the report as part of their service.
Alternate Names | DICOM, Slides, Scans
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
30. DiagnosticReport.media.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
31. DiagnosticReport.media.extension
Definition | 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
32. DiagnosticReport.media.modifierExtension
Definition | 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).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
33. DiagnosticReport.media.comment
Definition | 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.
Control | 0..1
Type | string
Requirements | The provider of the report should make a comment about each image included in the report.
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. DiagnosticReport.media.link
Definition | Reference to the image source.
Control | 1..1
Type | Reference(Media)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. DiagnosticReport.conclusion
Definition | Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.
Control | 0..1
Type | string
Must Support | true
Requirements | Need to be able to provide a conclusion that is not lost among the basic result data.
Alternate Names | Report
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. DiagnosticReport.conclusionCode
Definition | One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.
Control | 0..*
Binding | The codes SHOULD be taken from SNOMEDCTClinicalFindings This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).
Type | CodeableConcept
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
37. DiagnosticReport.presentedForm
Definition | Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.
Control | 0..*
Type | Attachment
Must Support | true
Requirements | Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.
Comments | "application/pdf" is recommended as the most reliable and interoperable in this context.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))