Generated Narrative: StructureDefinition diagnostic-report-obligation-eu-imaging Language: en Name Flags Card. Type Description & Constraints DiagnosticReport 0..* DiagnosticReportEuImaging A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports #xD; language O 0..1 code Language of the resource content Obligations Actor SHOULD:able-to-populate Imaging Report provider #xD; Slices for extension Content/Rules for all slices #xD; extension:artifactVersion O 0..1 ArtifactVersion(5.3.0-ballot) Business version of the artifact Obligations Actor MAY:able-to-populate Imaging Report provider #xD; extension:comparison O 0..* HL7IDRComparisonStudiesExt Extension: HL7IDR DiagnosticReport Comparison Study Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; extension:procedure O 0..* HL7IDRImagingProcedureExt Extension: HL7IDR Imaging Procedure Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; extension:impression O 0..* HL7IDRImpressionExt Extension: HL7IDR Impression Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; extension:recommendation O 0..* HL7IDRRecommendationExt Extension: HL7IDR Recommendation Obligations Actor SHOULD:able-to-populate Imaging Report provider #xD; extension:radiationDose O 0..1 RadiationDoseExt Extension: Radiation Dose Obligations Actor SHOULD:able-to-populate Imaging Report provider #xD; extension:informationRecipient O 0..* InformationRecipient(1.2.1-ci-build) Composition: Information recipient Obligations Actor SHOULD:able-to-populate Imaging Report provider #xD; identifier O 1..* Identifier Report identifier Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; Slices for basedOn Content/Rules for all slices #xD; basedOn:ServiceRequestOrderEuImagingaccession O 0..* Reference(ServiceRequest: Imaging Order) What was requested Obligations Actor MAY:able-to-populate Imaging Report provider #xD; status O 1..1 code Status of the Report Obligations Actor MAY:able-to-populate Imaging Report provider #xD; Slices for category Content/Rules for all slices #xD; category:diagnostic-service O 0..1 CodeableConcept Service category Obligations Actor MAY:able-to-populate Imaging Report provider #xD; subject O 1..1 Reference(Patient (EU core)) The subject of the report - usually, but not always, the patient Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; Slices for effective[x] 0..1 dateTime, Period Clinically relevant time/time-period for report Slice: Unordered, Open by type:$this #xD; effective[x]:effectivePeriod O 0..1 Period Clinically relevant time/time-period for report Obligations Actor SHOULD:able-to-populate Imaging Report provider #xD; issued O 0..1 instant Date and time of report issuance Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; Slices for performer Content/Rules for all slices #xD; performer:organization O 0..* Reference(Organization (EU core)) The organization producer of this report Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; Slices for resultsInterpreter Content/Rules for all slices #xD; resultsInterpreter:author O 0..* Reference(Practitioner (EU core) | PractitionerRole (EU core)) Primary result interpreter Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; note O 0..* Annotation Comments about the diagnostic report Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; media O 0..* BackboneElement Key images or data associated with this report Obligations Actor SHOULD:able-to-populate Imaging Report provider #xD; composition O 1..1 Reference(Composition: Imaging Report) Imaging Diagnostic Report Obligations Actor SHALL:able-to-populate Imaging Report provider #xD; presentedForm O 0..* Attachment Entire report as issued Obligations Actor SHOULD:able-to-populate Imaging Report provider #xD; Documentation for this format
DiagnosticReport: Imaging Report: Obligations
Obligations for DiagnosticReport: Imaging Report
Copyright HL7 Europe. Licensed under Creative Commons public domain (CC0 1.0).
A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
The findings and interpretation of diagnostic tests performed on patients, groups of patients, products, substances, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports. The report also includes non-clinical context such as batch analysis and stability reporting of products and substances.
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.
When a Composition is referenced in `Diagnostic.composition`, all Observation resources referenced in `Composition.entry` must also be referenced in `Diagnostic.entry` or in the references Observations in `Observation.hasMember`
composition.exists() implies (composition.resolve().section.entry.reference.where(resolve() is Observation) in (result.reference|result.reference.resolve().hasMember.reference))
If the resource is contained in another resource, it SHALL NOT contain nested Resources
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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()
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Entity, Role, or Act,Observation[classCode=OBS, moodCode=EVN]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
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 its narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
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.
Contained resources do not have a 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.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
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.
Must have either extensions or value[x], not both
The identifier that is used to identify this version of the artifact when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the artifact author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.
The anatomical regions covered by the study this report reports on.
The anatomical regions covered by the report, depending on the study there can be zero, one or more regions. The regions SHALL overlap with the bodysite references from `ImagingStudy.serie.bodysite`, if present.
This field is present in order to be able to populate the MHD DocumentReference field.
Extension: HL7IDR DiagnosticReport Comparison Study
Studies used for comparison in part of diagnostic reporting
Patient history items selected by radiologist
May have originally been extracted from the medical record by imaging staff, automated tools, or by the radiologists themselves.
Imaging procedure used for the imaging acquisition and procedure specific information.
Recommendations for any follow up actions
Communications with other care providers
Communications captures what communications have been made with other care providers.
Radiation dose information in the imaging report
This extension applies to the Composition resource and is used to represent an intended recipient of the composition.
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 managable, 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).
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.
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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifiers assigned to this Imaging Report by the performer or other systems. It shall be common to several report versions
Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists
OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4
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.
This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
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 managable, 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.
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient") - must be a resource in resources
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
DiagnosticReport.status and Composition.status shall be aligned
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"
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.
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.
inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
Defines the category of the report, Diagnostic imaging report.
Defines the priority category of the report as defined in the API spec.
Defines the document type, it is recommended to take this from the suggested LOINC set.
OBR-4 (HL7 V2 doesn't provide an easy way to indicate both the ordered test and the performed panel)
The subject of the report - usually, but not always, the patient
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.
PID-3 (no HL7 V2 mapping for Group or Device)
The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.
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).
Links the request to the Encounter context.
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Clinically relevant time/time-period for report
The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.
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.
Need to know where in the patient history to file/present this report.
The date and time that the report was issued. This is not necessarily the same as the date and time that the report was created, since a report may be revised and/or reviewed after it is created.
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.
The diagnostic service that is responsible for issuing the report.
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.
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.
PRT-8 (where this PRT-4-Participation = "PO")
The organization producer of this report
The organization responsible for producing this report. In case practitioners produce them in their private practices, they will be accounted as an organization for this purpose.
The practitioner or organization that is responsible for the report's conclusions and interpretations.
Might not be the same entity that takes responsibility for the clinical report.
OBR-32, PRT-8 (where this PRT-4-Participation = "PI")
Details about the specimens on which this diagnostic report is based.
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.
Need to be able to report information about the collected specimens on which the report is based.
R5 requires a .result element to be present if .composition is present. This mandatory cardinality fills that gap for the model in which no Observations are part of the report.
Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.
EHDSImagingReport.body.examinationReport.results[x], EHDSImagingReport.body.examinationReport.conclusion.impression
May include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.
EHDSImagingReport.body.examinationReport.results[x]; EHDSImagingReport.body.examinationReport.conclusion.impression
The type of annotation. This extension can be used to map the v2 NTE-4 comment type field.
This is used to identify the type of annotation.
Source of the definition for the extension code - a logical name or a URL.
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.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R5/extensibility.html) for a list).
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.
The annotation - text content (as markdown)
The text of the annotation in markdown format.
Study subject to this report. Note: Any associated study (e.g. comparison studies) used during reporting should be tracked in the associatedStudy extension.
For laboratory-type studies like GenomeStudy, type resources will be used for tracking additional metadata and workflow aspects of complex studies. ImagingStudy and the media element are somewhat overlapping - typically, the list of image references in the media 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.
Additional information supporting the diagnostic report
This backbone element contains supporting information that was used in the creation of the report not included in the results already included in the report.
Extensions that cannot be ignored even if unrecognized
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 managable, 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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The code value for the role of the supporting information in the diagnostic report.
The reference for the supporting information in the diagnostic report.
Key images or data associated with this report
A list of key images or data associated with this report. The images or data are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).
Comment about the image or data (e.g. explanation)
A comment about the image or data. Typically, this is used to provide an explanation for why the image or data is included, or to draw the viewer's attention to important features.
The comment should be displayed with the image or data. It would be common for the report to include additional discussion of the image or data contents or in other sections such as the conclusion.
The provider of the report should make a comment about each image or data included in the report.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
Reference to a Composition resource instance that provides structure for organizing the contents of the DiagnosticReport.
The Composition provides structure to the content of the DiagnosticReport (and only contains contents referenced in the DiagnosticReport) - e.g., to order the sections of an anatomic pathology structured report.
Clinical conclusion (interpretation) of test results
Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.
Need to be able to provide a conclusion that is not lost among the basic result data.
inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
Codes for the clinical conclusion of test results
One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.
inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.
"application/pdf" is recommended as the most reliable and interoperable in this context.