AU Core Implementation Guide
1.1.0-ci-build - CI Build Australia flag

AU Core Implementation Guide, published by HL7 Australia. This guide is not an authorized publication; it is the continuous build for version 1.1.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7au/au-fhir-core/ and changes regularly. See the Directory of published versions

Resource Profile: AU Core Pathology Result Observation

Official URL: http://hl7.org.au/fhir/core/StructureDefinition/au-core-diagnosticresult-path Version: 1.1.0-ci-build
Standards status: Trial-use Maturity Level: 2 Computable Name: AUCorePathologyResult

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License. HL7 Australia© 2022+; Licensed Under Creative Commons No Rights Reserved.

This profile sets minimum expectations for an Observation resource to record, search, and fetch pathology results associated with a patient. It is based on the AU Base Pathology Result profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets that SHALL be present in the Observation when conforming to this profile. It provides the floor for standards development for specific uses cases in an Australian context.

See Comparison with other national and international IGs for a comparison between AU Core profiles and profiles in other implementation guides.

Usage scenarios

The following are supported usage scenarios for this profile:

  • Query for pathology results for a patient
  • Query for category of pathology results (e.g. all chemistry)
  • Record or update pathology results belonging to a patient

Profile specific implementation guidance

  • Observation.category provides an efficient way of supporting system interactions, e.g. restricting searches. Implementers need to understand that data categorisation is somewhat subjective. The categorisation applied by the source may not align with a receiver’s expectations.
  • The observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
    • providing a local code
    • providing a more specific code
  • The use of coding can vary significantly across systems, requesters need to understand that they may encounter codes they do not recognise and be prepared to handle those resources appropriately. Responders SHOULD populate Observation.code.text and/or Observation.code.coding.display so that the requester can at least display the observation even if the requester does not recognise the code supplied.
  • The Observation resource can represent a result using a single value in Observation.value, or can represent a set of results using either Observation.component.value or Observation.hasMember.
    • Although all are marked as Must Support, responders are not required to support all choices, but they SHALL support at least one of these elements
    • A requester SHALL support all elements (Observation.value, Observation.component.value, Observation.hasMember)
    • for further guidance, see the Observation Grouping section in FHIR Specification.
  • Observation.identifier may contain the same identifier as in the order or report connecting the resources that are related to a single request fulfilment workflow.
  • Source system identifiers that identify the business process (order ids and reporting identifiers) MAY be included as AU Local Order Identifier and AU Local Report Identifier to support workflow and deduplication of Observation resources.
    • See guidance on the construction of an identifier on the relevant Identifier profile page and the section on Business Identifiers in AU Base.

Usage:

Changes since version 1.0.0:

  • The resource metadata has changed (description)

    • Formal Views of Profile Content

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

    This structure is derived from AUBasePathologyResult

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* AUBasePathologyResult A pathology test result in an Australian healthcare context
    au-core-obs-01: If there is no component or hasMember element then at least value or data absent reason shall be present
    ... status SO 1..1 code registered | preliminary | final | amended +
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... category SO 1..* CodeableConcept Classification of the service requested as laboratory + more specific discipline where available
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SO 1..1 CodeableConcept Pathology test or test group
    Binding: RCPA SPIA Pathology Reporting . (extensible)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... effective[x] SOC 1..1 dateTime, Period Time of specimen collection
    au-core-obs-02: Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... performer SO 0..* Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Core RelatedPerson) Who is responsible for the observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... value[x] SOC 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... dataAbsentReason SOC 0..1 CodeableConcept Why the result is missing
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... interpretation SO 0..* CodeableConcept High, low, normal, etc.
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... specimen SO 0..1 Reference(AU Base Specimen) Specimen used for this observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... referenceRange SO 0..* BackboneElement Provides guide for interpretation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... low SO 0..1 SimpleQuantity Low Range, if relevant
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... high SO 0..1 SimpleQuantity High Range, if relevant
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... type SO 0..1 CodeableConcept Reference range qualifier
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... text SO 0..1 string Text based reference range in an observation
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... hasMember SO 0..* Reference(AU Core Pathology Result Observation) Individual observations in a group, study, or panel
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... component SOC 0..* BackboneElement Individual tests in a group or panel
    au-core-obs-03: The component shall at least have a value or a data absent reason
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... code SO 1..1 CodeableConcept Individual pathology test
    Binding: RCPA SPIA Pathology Reporting . (extensible)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... value[x] SOC 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual component result
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... dataAbsentReason SOC 0..1 CodeableConcept Why the component result is missing
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.codeextensibleRCPASPIAPathologyReporting .
    https://healthterminologies.gov.au/fhir/ValueSet/spia-pathology-reporting-1
    Observation.component.codeextensibleRCPASPIAPathologyReporting .
    https://healthterminologies.gov.au/fhir/ValueSet/spia-pathology-reporting-1

    Constraints

    IdGradePath(s)DetailsRequirements
    au-core-obs-01errorObservationIf there is no component or hasMember element then at least value or data absent reason shall be present
    : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
    au-core-obs-02errorObservation.effective[x]Date shall be at least to day or, if not available, the Data Absent Reason extension shall be present
    : (($this is dateTime implies $this.toString().length() >= 10) and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not()) xor ($this is dateTime implies ($this.hasValue().not() and extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists()))
    au-core-obs-03errorObservation.componentThe component shall at least have a value or a data absent reason
    : value.exists() or dataAbsentReason.exists()

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Below is an overview of the mandatory and optional search parameters and combined search parameters. See the AU Core CapabilityStatements for a complete list of supported RESTful interactions for this IG.

    FHIR search operations are described here and the syntax used to describe AU Core interactions is defined here.

    Any search parameter defined in FHIR may be ‘allowed’ by the system unless explicitly marked as “SHALL NOT”. A few items are marked as MAY in this implementation guide to highlight their potential relevance.

    Parameter(s) Conformance Type(s) Requirements (when used alone or in combination)
    patient+category SHALL reference+token
    patient+category+date SHALL reference+token+date
    patient+code SHALL reference+token
    patient+category+status SHOULD reference+token+token
    patient+code+date SHOULD reference+token+date
    patient MAY reference The requester SHALL provide at least an id value and MAY provide both the Type and id values. The responder SHALL support both.

    The requester SHOULD support chained search patient.identifier using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile. The responder SHOULD support chained search patient.identifier using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile.
    category MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHALL support search using the category code defined in this profile. The responder SHALL support search using the category code defined in this profile.
    code MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHALL support search using the LOINC codes defined in this profile. The responder SHALL support search using the LOINC codes defined in this profile.

    The requester SHALL support multipleOr. The responder SHALL support multipleOr.
    date MAY date A requester SHALL provide a value precise to the second + time offset. A responder SHALL support a value precise to the second + time offset.

    The requester SHALL support these search comparators gt, lt, ge, le. The responder SHALL support these search comparators gt, lt, ge, le.

    The requester SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le. The responder SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le.
    status MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHALL support multipleOr.The responder SHALL support multipleOr.

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching using the combination of the patient and category search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory

      Example:

      1. GET [base]/Observation?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = laboratory (how to search by reference and how to search by token)

    2. SHALL support searching using the combination of the patient and code search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHOULD support multipleOr search on code (e.g.code={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=5678&code=http://loinc.org|6690-2,http://loinc.org|789-8

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). The Observation code parameter searches Observation.code only. (how to search by reference and how to search by token)

    3. SHALL support searching using the combination of the patient and category and date search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support these date comparators: gt,lt,ge,le
      • SHOULD support multipleAnd search on date (e.g.date=[date]&date=[date]]&...), and if multipleAnd is supported, SHALL support the search comparators gt,lt,ge,le

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&date=ge2020-01-01T00:00:00Z 1. GET [base]/Observation?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = laboratory (how to search by reference and how to search by token and how to search by date)

    Optional Search Parameters:

    The following search parameters and search parameter combinations SHOULD be supported:

    1. SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/Observation?patient.identifier=[system|][code]

      Example:

      1. GET [base]/Observation?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952
      2. GET [base]/Observation?patient.identifier=http://ns.electronichealth.net.au/id/hi/ihi/1.0|8003608833357361

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and category and status search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support multipleOr search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&status=final

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and status (how to search by reference and how to search by token)

    3. SHOULD support searching using the combination of the patient and code and date search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code]
      • SHOULD support multipleOr search on code (e.g.code={system|}[code],{system|}[code],...)
      • SHALL support these date comparators: gt,lt,ge,le
      • SHOULD support multipleAnd search on date (e.g.date=[date]&date=[date]]&...), and if multipleAnd is supported, SHALL support the search comparators gt,lt,ge,le

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=5678&code=http://loinc.org|6690-2,http://loinc.org|789-8&date=ge2020-01-01T00:00:00Z
      2. GET [base]/Observation?patient.identifier=http://example.org/fhir/mrn|12345&code=http://loinc.org|6690-2,http://loinc.org|789-8&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and observation code(s) (how to search by reference and how to search by token and how to search by date)