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FHIRcast, published by HL7 International / Infrastructure And Messaging. This guide is not an authorized publication; it is the continuous build for version 3.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhircast-docs/ and changes regularly. See the Directory of published versions

DiagnosticReport-update Event

Page standards status: Informative

Event-name: DiagnosticReport-update

eventMaturity 2 - Tested

The DiagnosticReport-update event is used by Subscribers to support content sharing in communication with a Hub which also supports content sharing. A DiagnosticReport-update request will be posted to the Hub when a Subscriber desires to add, change, or remove exchanged information in the anchor context. For a DiagnosticReport-update, the anchor context is the DiagnosticReport context established by the corresponding DiagnosticReport-open. One or more update requests MAY occur while the anchor context is open.

The updates that may be included in the updates bundle include:

  • adding, updating, or removing FHIR resources contained in the DiagnosticReport
  • updating attribute values of the DiagnosticReport or associated context resources (Patient and/or ImagingStudy resources)

Context

Key Cardinality Type Description
report 1..1 reference Reference to the FHIR DiagnosticReport resource specifying the anchor context in which the update is being made.
patient 0..1 reference May be provided so that Subscribers may perform identity verification according to their requirements.
updates 1..1 resource Contains a single Bundle resource holding changes to be made to the current content of the anchor context

The following profiles provide guidance as to which resource attributes should be present and considerations as to how each attribute should be valued in a DiagnosticReport-update request:

Supported Update Request Methods

Each entry in the updates Bundle resource contains a method in that entry's request attribute. The Bundle profile specifies the allowed methods: PUT can be used to add a new resource or update an existing resource, DELETE removes an existing resource.

Number of Entries in Transaction Bundle

Refer to Number of Entries in Transaction Bundle in Content Sharing for more information.

Examples

App adds ImagingStudy and Observation to DiagnosticReport

The following example shows adding an imaging study and a new observation to the existing diagnostic report context. The context.versionId matches the context.versionId provided by the Hub in the most recent DiagnosticReport-open or DiagnosticReport-update event. The report key in the context array holds the id of the diagnostic report and is required in all DiagnosticReport-update events. The Bundle in the updates key holds the addition (PUT) of an imaging study, adds (PUT) an observation derived from this study, and updates the DiagnosticReport to reference these new resources, in addition to the pre-existing result ("No significant lymphadenopathy").

{
  "timestamp": "2019-09-10T14:58:45.988Z",
  "id": "cc4d016a-f516-4ce7-8f1a-e0baf0beb94d",
  "event": {
    "hub.topic": "fdb2f928-5546-4f52-87a0-0648e9ded065",
    "hub.event": "DiagnosticReport-update",
    "context.versionId": "b9574cb0-e9e5-4be1-8957-5fcb51ef33c1",
    "context": [
      {
        "key": "report",
        "reference": { "reference": "DiagnosticReport/2402d3bd-e988-414b-b7f2-4322e86c9327"
        }
      },
      {
        "key": "patient",
        "reference": { 
          "reference": "Patient/503824b8-fe8c-4227-b061-7181ba6c3926"
        }
      },
      {
        "key": "updates",
        "resource": {
          "resourceType": "Bundle",
          "type": "transaction",
          "entry": [
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "ImagingStudy",
                "description": "CHEST XRAY",
                "started": "2010-02-14T01:10:00.000Z",
                "id": "7e9deb91-0017-4690-aebd-951cef34aba4",
                "identifier": [
                  {
                    "type": {
                      "coding": [
                        {
                          "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code": "ACSN"
                        }
                      ]
                    },
                    "value": "3478116342"
                  },
                  {
                    "system": "urn:dicom:uid",
                    "value": "urn:oid:2.16.124.113543.6003.1154777499.30276.83661.3632298176"
                  }
                ]
              }
            },
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "Observation",
                "id": "40afe766-3628-4ded-b5bd-925727c013b3",
                "identifier": [
                  {
                    "system":"http://hospital.example.org",
                    "value":"7611ffcd-f242-4738-b451-31995b660b90"
                  }
                ]
                "partOf": {
                  "reference": "ImagingStudy/7e9deb91-0017-4690-aebd-951cef34aba4"
                },
                "status": "preliminary",
                "category": {
                  "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                  "code": "imaging",
                  "display": "Imaging"
                },
                "code": {
                  "coding": [
                    {
                      "system": "http://www.radlex.org",
                      "code": "RID49690",
                      "display": "simple cyst"
                    }
                  ] 
                },
                "issued": "2020-09-07T15:02:03.651Z"
              }
            },
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "DiagnosticReport",
                "id": "2402d3bd-e988-414b-b7f2-4322e86c9327",
                "identifier" : [
                  {
                    "use" : "official",
                    "system" : "http://myhealthcare.example.org/reporting-system",
                    "value" : "GH339884.RPT.0001"
                  }
                ],
                "imagingStudy": [
                  {
                    "reference": "ImagingStudy/7e9deb91-0017-4690-aebd-951cef34aba4"
                  }
                ],
                "result": [
                  {
                    "reference": "Observation/1e057514-e069-4eb1-aed9-5e70c693fe28",
                    "display": "No significant lymphadenopathy"
                  },
                  {
                    "reference": "Observation/40afe766-3628-4ded-b5bd-925727c013b3",
                    "display": "Microcalcifications in left breast"
                  }
                ]
              }
            }
          ]
        }
      }
    ]
  }
}
Hub broadcasts with new versionid

The Hub distributes the corresponding event to all Subscribers. The Hub replaces the context.versionId in the request with a new context.versionId generated by the Hub. The prior version, context.priorVersionId of the context enables continuity. If the value of context.priorVersionId is not in agreement with the context.versionId last received by a Subscriber, the Subscriber can retrieve the current context.

{
  "timestamp": "2019-09-10T14:58:45.988Z",
  "id": "cc4d016a-f516-4ce7-8f1a-e0baf0beb94d",
   "event": {
    "hub.topic": "fdb2f928-5546-4f52-87a0-0648e9ded065",
    "hub.event": "DiagnosticReport-update",
    "context.versionId": "efcac43a-ed38-49e4-8d79-73f78290292a",
    "context.priorVersionId": "b9574cb0-e9e5-4be1-8957-5fcb51ef33c1",
    "context": [
      {
        "key": "report",
        "reference": { "reference" : "DiagnosticReport/2402d3bd-e988-414b-b7f2-4322e86c9327"
        }
      },
      {
        "key": "patient",
        "reference": { "reference": "Patient/503824b8-fe8c-4227-b061-7181ba6c3926"
        }
      },
      {
        "key": "updates",
        "resource": {
          "resourceType": "Bundle",
          "type": "transaction",
          "entry": [
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "ImagingStudy",
                "description": "CHEST XRAY",
                "started": "2010-02-14T01:10:00.000Z",
                "id": "7e9deb91-0017-4690-aebd-951cef34aba4",
                "identifier": [
                  {
                    "type": {
                      "coding": [
                        {
                          "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code": "ACSN"
                        }
                      ]
                    },
                    "value": "3478116342"
                  },
                  {
                    "system": "urn:dicom:uid",
                    "value": "urn:oid:2.16.124.113543.6003.1154777499.30276.83661.3632298176"
                  }
                ]
              }
            },
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "Observation",
                "id": "40afe766-3628-4ded-b5bd-925727c013b3",
                "identifier": [
                  {
                    "system":"http://hospital.example.org",
                    "value":"7611ffcd-f242-4738-b451-31995b660b90"
                  }
                ]
                "partOf": {
                  "reference": "ImagingStudy/7e9deb91-0017-4690-aebd-951cef34aba4"
                },
                "status": "preliminary",
                "category": {
                  "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                  "code": "imaging",
                  "display": "Imaging"
                },
                "code": {
                  "coding": [
                    {
                      "system": "http://www.radlex.org",
                      "code": "RID49690",
                      "display": "simple cyst"
                    }
                  ] 
                },
                "issued": "2020-09-07T15:02:03.651Z"
              }
            },
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "DiagnosticReport",
                "id": "2402d3bd-e988-414b-b7f2-4322e86c9327",
                "identifier" : [
                  {
                    "use" : "official",
                    "system" : "http://myhealthcare.example.org/reporting-system",
                    "value" : "GH339884.RPT.0001"
                  }
                ],
                "imagingStudy": [
                  {
                    "reference": "ImagingStudy/7e9deb91-0017-4690-aebd-951cef34aba4"
                  }
                ],
                "result": [
                  {
                    "reference": "Observation/1e057514-e069-4eb1-aed9-5e70c693fe28",
                    "display": "No significant lymphadenopathy"
                  },
                  {
                    "reference": "Observation/40afe766-3628-4ded-b5bd-925727c013b3",
                    "display": "Microcalcifications in left breast"
                  }
                ]
              }
            }
          ]
        }
      }
    ]
  }
}
App later deletes Observation from DiagnosticReport

The following example shows a request to delete an observation from a content sharing session.

{
  "timestamp": "2019-09-10T15:02:33.343Z",
  "id": "d30734f1-3c7d-4fe4-a343-fbf4d80faddb",
  "event": {
    "hub.topic": "fdb2f928-5546-4f52-87a0-0648e9ded065",
    "hub.event": "DiagnosticReport-update",
    "context.versionId": "efcac43a-ed38-49e4-8d79-73f78290292a",
    "context": [
      {
        "key": "report",
        "reference": { "reference": "DiagnosticReport/2402d3bd-e988-414b-b7f2-4322e86c9327"
        }
      },
      {
        "key": "patient",
        "reference": { "reference": "Patient/503824b8-fe8c-4227-b061-7181ba6c3926"
        }
      },
      {
        "key": "updates",
        "resource": {
          "resourceType": "Bundle",
          "type": "transaction",
          "entry": [
            {
              "fullUrl": "Observation/40afe766-3628-4ded-b5bd-925727c013b3",
              "request": {
                "method": "DELETE"
              }
            },
            {
              "request": {
                "method": "PUT"
              },
              "resource": {
                "resourceType": "DiagnosticReport",
                "id": "2402d3bd-e988-414b-b7f2-4322e86c9327",
                "identifier" : [
                  {
                    "use" : "official",
                    "system" : "http://myhealthcare.example.org/reporting-system",
                    "value" : "GH339884.RPT.0001"
                  }
                ],
                "imagingStudy": [
                  {
                    "reference": "ImagingStudy/7e9deb91-0017-4690-aebd-951cef34aba4"
                  }
                ],
                "result": [
                  {
                    "reference": "Observation/1e057514-e069-4eb1-aed9-5e70c693fe28",
                    "display": "No significant lymphadenopathy"
                  }
                ]
              }
          ]
        }
      }
    ]
  }
}

Change Log

Version Description
0.1 Initial draft
1.0 Updated for STU3