LaboratoryTestResult - RIVO-Noord Zorgviewer Implementation Guide v1.9.1

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.9.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RIVO-Noord/zorgviewer-ig/ and changes regularly. See the Directory of published versions

Resource Profile: LaboratoryTestResult

Official URL: http://hl7.nl/fhir/zorgviewer/StructureDefinition/LaboratoryTestResult				Version: 1.9.1
Active as of 2024-12-10				Computable Name: LaboratoryTestResult

Laboratorium Test Uitslag

Dit Profiel is het resultaat van de vergelijking tussen de zib2017 FHIR Profiel en de implementaties in Epic, Chipsoft, Topicus en Nexus. De elementen die in ieder geval in alle output beschikbaar zullen zijn. Voornamelijk bedoeld voor houvast van een client en voor validatie van output.

Zorginformatiebouwsteen

ZIB Laboratorium uitslag

User-Interface guidance

Een schets van het scherm met labels en sortering informatie

Kolom definities:

Kolom label FHIR Path FHIR Type Zib element Toelichting of regels

Bron .meta.extension("http://hl7.org/fhir/4.0/StructureDefinition/extension-Meta.source").valueUri string nvt Lookup adhv uri (AGB-Z of OID) <adressering-base>/Organization?identifier=<.meta.tag.code> en gebruik dan Organization.name

Afnamedatum .specimen.resolve().collection.collectedDateTime dateTime Monster/ AfnameDatumTijd

Test .code.text string TestCode

Testuitslag (interpretatie) .valueString of .valueQuantity.value + .valueQuantity.unit + (.interpretation.code zie toelichting) decimal + string (+ icon) TestUitslag, InterpretatieVlaggen .interpretation.code
"AA": uitroepteken icon, kritiek
"281302008" of "H": pijl omhoog, boven de bovengrens
"281300000" of "L": pijl naar beneden, onder de ondergrens
N.B. Resistent, Intermediar en Sensitief vanuit de standaard zijn niet van toepassing op de klinische chemie.

Epic: Indien lab-order geannuleerd, dan wordt deze kolom gevuld met "GEANNULEERD". Dit is voor nu akkoord bevonden door stuurgroep Zorgviewer.

Onder- en bovengrens .referenceRange.low.value '–' .referenceRange.high.value + .referenceRange.high.unit
indien low.unit en high.unit niet gelijk zijn aan elkaar:
.referenceRange.low.value + .referenceRange.low.unit '–' .referenceRange.high.value + .referenceRange.high.unit decimal + string ReferentieOndergrens, ReferentieBovengrens

Materiaal .specimen.resolve().type.text string Monster/ Monstermateriaal

Status .status code ResultaatStatus Epic: Indien lab-order geannuleerd, dan krijgt dit alsnog de status Definitief met een Testuitslag van "GEANNULEERD". Dit is voor nu akkoord bevonden door stuurgroep Zorgviewer.

(1) UITKLAPVELD

Commentaar .comment string Toelichting

Toelichting materiaal .specimen.revolve().note.text string Monster/ Toelichting

Kolom label	FHIR Path	FHIR Type	Zib element	Toelichting of regels
Bron	`.meta.extension("http://hl7.org/fhir/4.0/StructureDefinition/extension-Meta.source").valueUri`	`string`	nvt	Lookup adhv uri (AGB-Z of OID) `<adressering-base>/Organization?identifier=<.meta.tag.code>` en gebruik dan `Organization.name`
Afnamedatum	`.specimen.resolve().collection.collectedDateTime`	`dateTime`	Monster/ AfnameDatumTijd
Test	`.code.text`	`string`	TestCode
Testuitslag (interpretatie)	`.valueString` of `.valueQuantity.value` + `.valueQuantity.unit` + (`.interpretation.code` zie toelichting)	`decimal + string (+ icon)`	TestUitslag, InterpretatieVlaggen	`.interpretation.code` `"AA"`: uitroepteken icon, kritiek `"281302008" of "H"`: pijl omhoog, boven de bovengrens `"281300000" of "L"`: pijl naar beneden, onder de ondergrens N.B. Resistent, Intermediar en Sensitief vanuit de standaard zijn niet van toepassing op de klinische chemie. Epic: Indien lab-order geannuleerd, dan wordt deze kolom gevuld met `"GEANNULEERD"`. Dit is voor nu akkoord bevonden door stuurgroep Zorgviewer.
Onder- en bovengrens	`.referenceRange.low.value` '–' `.referenceRange.high.value` + `.referenceRange.high.unit` indien low.unit en high.unit niet gelijk zijn aan elkaar: `.referenceRange.low.value` + `.referenceRange.low.unit` '–' `.referenceRange.high.value` + `.referenceRange.high.unit`	`decimal + string`	ReferentieOndergrens, ReferentieBovengrens
Materiaal	`.specimen.resolve().type.text`	`string`	Monster/ Monstermateriaal
Status	`.status`	`code`	ResultaatStatus	Epic: Indien lab-order geannuleerd, dan krijgt dit alsnog de status Definitief met een Testuitslag van `"GEANNULEERD"`. Dit is voor nu akkoord bevonden door stuurgroep Zorgviewer.
(1) UITKLAPVELD
Commentaar	`.comment`	`string`	Toelichting
Toelichting materiaal	`.specimen.revolve().note.text`	`string`	Monster/ Toelichting

Zoeken naar codes

LOINC lab-uitslagen - system=http://loinc.org

Request

Opvragen (search) laatst bekende labuitslag per type (inclusief materiaalsoort) voor een patient

GET <ontsluiten-bronsysteem-base>/Observation/$lastn?patient=<fhir_patient_id>&category=http://snomed.info/sct|275711006&_include=Observation:specimen

N.B. Alleen klinische chemie resultaten zijn op dit moment beschikbaar.

Bronsysteem herkennen

De Zorgviewer-backend of Ontsluiten bronsysteem MOET na bevragen van het bronsysteem aan elk resultaat resource een meta-tag toevoegen met de AGB, OID of URA identifier van de zorgaanbieder (zie Organization voor voorbeelden). Dit wordt vervolgens gebruikt in de "Bron" kolom in de Zorgviewer-frontend. N.B. We gebruiken hier een pre-adopt van de FHIR R4 Meta.source.

Toevoegen aan elke response, dus per resource (bij een read) of per Bundle (bij een search):

"meta": {
    "extension": [ {
        "url": "http://hl7.org/fhir/4.0/StructureDefinition/extension-Meta.source",
        "valueUri": "urn:oid:2.16.840.1.113883.2.4.3.8"
    } ]
}

Alternatief: Elke entry van een search response Bundle bevat een referentie naar de bijbehorende Patient (<resource>.subject|patient). Elke patient heeft een Patient.managingOrganization en in de gerefereerde Organization.identifier staat vervolgens o.a. de OID van het bronsysyeem. Of je gebruikt de identifiers om een volledige Organization op te zoeken in het adresboek en zie inhoud hier.

Usage:

This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from Zib LaboratoryTestResult Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Zib LaboratoryTestResult Observation	LaboratoryTestResult
status	S	1..1	code	TestUitslagStatus
code
text	S	0..1	string	Plain text representation of the concept
effectiveDateTime	S	0..1	dateTime	TestDateTime
valueQuantity	S	0..1	Quantity	TestResult
value	S	0..1	decimal	Numerical value (with implicit precision)
unit	S	0..1	string	Unit representation
interpretation
coding
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
specimen	S	0..1	Reference(Specimen)	Specimen
referenceRange
low
value	S	0..1	decimal	Numerical value (with implicit precision)
unit	S	0..1	string	Unit representation
high
value	S	0..1	decimal	Numerical value (with implicit precision)
unit	S	0..1	string	Unit representation
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Zib LaboratoryTestResult Observation	LaboratoryTestResult dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	TestUitslagStatus Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for extension				Content/Rules for all slices
TestResultStatus		0..1	(Complex)	TestResultStatus URL: http://nictiz.nl/fhir/StructureDefinition/code-specification ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
url		1..1	uri	"http://nictiz.nl/fhir/StructureDefinition/code-specification"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept		1..1	CodeableConcept	Value of extension Binding: ResultaatStatusCodelijst (extensible): TestResultStatusCodelist
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: Observation Category Codes (preferred): Codes for high level observation categories.
category:LaboratoryTestResultCode		1..1	CodeableConcept	LaboratoryTestResultCode Binding: Observation Category Codes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 49581000146104
category:ResultType		0..1	CodeableConcept	ResultType Binding: ResultaatTypeCodelijst (required): ResultaatTypeCodelijst
code	Σ	1..1	CodeableConcept	TestCode or PanelOrBattery Binding: LOINC Codes (example): Codes identifying names of simple observations.
text	SΣ	0..1	string	Plain text representation of the concept
subject	Σ	1..1	Reference(Group \| Device \| nl-core-location \| nl-core-patient)	Patient
Slices for effective[x]	Σ	0..1	dateTime	TestDateTime Slice: Unordered, Closed by type:$this
effective[x]:effectiveDateTime	SΣ	0..1	dateTime	TestDateTime
Slices for value[x]	ΣC	0..1	Quantity	TestResult Slice: Unordered, Closed by type:$this
value[x]:valueQuantity	SΣC	0..1	Quantity	TestResult
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	0..1	string	Unit representation
interpretation		0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.
Slices for coding	ΣC	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system zib-LaboratoryTestResult-Observation-1: If a value from the HCIM ValueSet 'InterpretatieVlaggenCodelijst' is present a mapped code from the FHIR ValueSet 'Observation Interpretation Codes' is also expected. A ConceptMap is available that maps the HCIM values to the FHIR values.
coding:All Slices				Content/Rules for all slices
code	SΣ	0..1	code	Symbol in syntax defined by the system
coding:ObservationInterpretation	Σ	0..*	Coding	Code defined by a terminology system Binding: Observation Interpretation Codes (required): Observation Interpretation Codes
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/v2/0078
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:InterpretatieVlaggenCodelijst	Σ	0..*	Coding	ResultFlags Binding: InterpretatieVlaggenCodelijst (required): InterpretatieVlaggenCodelijst
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SΣ	0..1	string	Plain text representation of the concept
specimen	S	0..1	Reference(Specimen)	Specimen
referenceRange	C	0..*	BackboneElement	Reference ele-1: All FHIR elements must have a @value or children obs-3: Must have at least a low or a high or text
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
low	C	0..1	SimpleQuantity	ReferenceRangeLowerLimit
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
unit	SΣ	0..1	string	Unit representation
high	C	0..1	SimpleQuantity	ReferenceRangeUpperLimit
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
unit	SΣ	0..1	string	Unit representation
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	ObservationStatus `http://hl7.org/fhir/ValueSet/observation-status` from the FHIR Standard
Observation.status.extension:TestResultStatus.value[x]:valueCodeableConcept	extensible	ResultaatStatusCodelijst `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.8--20171231000000`
Observation.category	preferred	Observation Category Codes `http://hl7.org/fhir/ValueSet/observation-category` from the FHIR Standard
Observation.category:LaboratoryTestResultCode	preferred	Pattern: SNOMED-CT Code 49581000146104 `http://hl7.org/fhir/ValueSet/observation-category` from the FHIR Standard
Observation.category:ResultType	required	ResultaatTypeCodelijst `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.1--20171231000000`
Observation.code	example	LOINC Codes (a valid code from LOINC) `http://hl7.org/fhir/ValueSet/observation-codes` from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator `http://hl7.org/fhir/ValueSet/quantity-comparator` from the FHIR Standard
Observation.interpretation	extensible	Observation Interpretation Codes `http://hl7.org/fhir/ValueSet/observation-interpretation` from the FHIR Standard
Observation.interpretation.coding:ObservationInterpretation	required	Observation Interpretation Codes `http://hl7.org/fhir/ValueSet/observation-interpretation` from the FHIR Standard
Observation.interpretation.coding:InterpretatieVlaggenCodelijst	required	InterpretatieVlaggenCodelijst `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000`

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	Observation	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()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() \| (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If code is the same as a component code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()
zib-LaboratoryTestResult-Observation-1	error	Observation.interpretation.coding	If a value from the HCIM ValueSet 'InterpretatieVlaggenCodelijst' is present a mapped code from the FHIR ValueSet 'Observation Interpretation Codes' is also expected. A ConceptMap is available that maps the HCIM values to the FHIR values. : coding.where(system = 'http://snomed.info/sct' and (code = '281302008' or '281300000' or '11896004' or '30714006' or '131196009') ).exists() implies coding.where(system = 'http://hl7.org/fhir/v2/0078').exists()

Description & Constraints

Observation

0..*

Zib LaboratoryTestResult Observation

LaboratoryTestResult
obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present

0..1

Logical id of this artifact

Terminology Bindings

Path Conformance ValueSet / Code URI

Observation.language