Order Catalog Implementation Guide
1.0.0 - STU 1

Order Catalog Implementation Guide, published by HL7 International / Orders and Observations. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. 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

Page standards status: Informative

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 Lab examples sections.

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.

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

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.

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

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.

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

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.

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

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.

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

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 figure below displays the business content.

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

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.

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

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