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CH ELM (R4), published by Federal Office of Public Health FOPH. This is not an authorized publication; it is the continuous build for version 1.0.0-ci-build). This version is based on the current content of and changes regularly. See the Directory of published versions


Official URL: Version: 1.0.0-ci-build
Draft as of 2023-09-19 Computable Name: CH_ELM

Copyright/Legal: CC0-1.0


CH ELM is a project of the Swiss Federal Office of Public Health (FOPH), Communicable Diseases Division, to enable laboratories to send their observations of notifiable communicable infectious diseases to the FOPH electronically. A report is created as a specialized Clinical Document based on the HL7® FHIR® standard. This FHIR document is sent to the FOPH by a FHIR RESTful web API endpoint. CH ELM derives from the Swiss implementation guides and the European laboratory project (see graphical overview).

The expected content of the FHIR document, based on the ordinance of the Federal Office of Public Health (DE, FR, IT), is defined in the logical model. A mapping shows how to access the data from the FHIR document. In addition, further documentation for specific topics can be found on the guidance page and the use cases (DE) describe the different scenarios with respective examples for specific organisms.

The specification herewith documented is work in progress. No liability can be inferred from the use or misuse of this specification, or its consequences.

Changelog with significant changes, open and closed issues.

Download: You can download this implementation guide in npm format from here.

Implementation Support for Laboratories

This guide supports you as a laboratory in the following way:

  • Use cases (DE) describe the different scenarios with respective example reports for specific organisms, e.g. for Neisseria gonorrhoeae in xml or json, you choose if you want to provide the FHIR laboratory report in xml or json format.
  • What needs to be defined in the laboratory report is defined in FHIR document, profiles define the constraints on FHIR resources which need to be included in the report, see the overview here.
  • The data elements defined by the ordinance of the Federal Office of Public Health (FOPH) for the report are defined in the logical model and are then mapped to the FHIR document structure.
  • Value sets for the terminology are provided as FHIR resources which you can directly import from the npm package.
  • The laboratory report is sent to the FOPH by a FHIR RESTful web API endpoint.
  • Further documentation for specific topics can be found on the guidance.

FHIR R4 has a huge implementation community and offers various libraries to support the implementation of FHIR based solutions, for creating the FHIR document or providing a client for doing the FHIR API calls. For java we recommend hapi-fhir, for .NET firely-net-sdk, but there are also multiple other options. If you have questions about general FHIR questions do not hesitate to ask in

To check if your report is valid to the requirements of this implementation guide you can check it with the FHIR Validator providing this package as a parameter and specifying the profile

Since the FHIR API is standardized you can test your client also against a public FHIR test server like hapi.

If you have general feedback this implementation guide you find at the bottom a “Propose a change” link where you can raise an issue.

Must Support

For the CH ELM exchange format, the mustSupport flag set to true has the following meaning:
If the sending application has data for the element, it is required to populate the element with a non-empty value. If the value is not known, the element may be omitted.

IP Statements

HL7®, HEALTH LEVEL SEVEN®, FHIR® and the FHIR ® are trademarks owned by Health Level Seven International, registered with the United States Patent and Trademark Office.

This publication includes IP covered under the following statements.

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 ( and R4B ( are available.


Dependency Overview

This overview illustrates the relevant dependencies of CH ELM to the Swiss implementation guides and the European laboratory project.

Fig. 1: Dependency Overview

Fig. 1: Dependency Overview

Dependency Table

.. CH ELM (R4)
... HL7 Terminology (THO)hl7.terminology.r4#5.3.0R4Automatically added as a dependency - all IGs depend on HL7 Terminology
... CH LAB-Report (R4)
.... FHIR Extensions Packhl7.fhir.uv.extensions.r4#1.0.0R4
.... CH Core (R4)
..... CH EPR
...... IHE FormatCode Vocabularyihe.formatcode.fhir#1.1.0R4
...... HL7 Terminology (THO)hl7.terminology#5.1.0R4
.... International Patient Summary Implementation Guidehl7.fhir.uv.ips#currentR4
..... HL7 Terminology (THO)hl7.terminology.r4#5.0.0R4
..... fhir.dicom#2022.4.20221006R4
.... HL7 Europe Laboratory
.... CH LAB-Order (R4)
..... CH ORF (R4)
...... CH Core (R4)
...... Structured Data Capturehl7.fhir.uv.sdc#3.0.0R4
....... FHIR R4 package : Exampleshl7.fhir.r4.examples#4.0.1R4
..... Order Catalog Implementation Guidehl7.fhir.uv.order-catalog#0.1.0R4

Package hl7.fhir.uv.extensions.r4#1.0.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package ihe.formatcode.fhir#1.1.0

Implementation Guide for IHE defined FormatCode vocabulary. (built Thu, Feb 24, 2022 16:55-0600-06:00)


Implementation guide for the meta data specified in the framework of Annex 3 and 9 of the FDHA Ordinance on the electronic patient record in Switzerland (built Tue, Jun 27, 2023 18:05+0200+02:00)


FHIR implementation guide CH Core (built Wed, Sep 20, 2023 12:49+0000+00:00)

Package hl7.fhir.uv.ips#current

International Patient Summary (IPS) FHIR Implementation Guide (built Wed, Dec 7, 2022 16:30+0000+00:00)


This guide describes how the Laboratory Report can be represented in the European REALM. (built Wed, Sep 20, 2023 11:16+0000+00:00)


FHIR implementation guide CH Core (built Tue, Jun 27, 2023 23:13+0200+02:00)

Package hl7.fhir.r4.examples#4.0.1

Example resources in the R4 version of the FHIR standard

Package hl7.fhir.uv.sdc#3.0.0

The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR.
This includes two components:
* Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains.
*Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)


Order & Referral by Form - Implementation Guide (CH ORF) (built Thu, Jun 29, 2023 21:19+0200+02:00)

Package hl7.fhir.uv.order-catalog#0.1.0

An Order Catalog is an administered homogeneous collection of items such as medication products, laboratory tests, procedures, medical devices or knowledge artifacts such as order sets, which support the ordering process, or more generally healthcare processes. (built Sun, Aug 9, 2020 15:18+0000+00:00)


Implementation guide CH LAB-Order (R4) (built Thu, Jun 29, 2023 23:13+0200+02:00)


FHIR® Implementation Guide for Laboratory Reports in Switzerland (built Thu, Sep 14, 2023 20:53+0000+00:00)

Globals Table

There are no Global profiles defined