NHS North West Genomics, published by NHS North West Genomics. This guide is not an authorized publication; it is the continuous build for version 0.0.8 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/nw-gmsa/nw-gmsa.github.com/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON

: Collect Specimen - Biopsy Procedure for obtaining a specimen, part of a diagnostic pathway. Day case admission. - XML Representation

Draft as of 2025-10-30

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<ExampleScenario xmlns="http://hl7.org/fhir">
  <id value="BiopsyProcedure"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ExampleScenario BiopsyProcedure</b></p><a name="BiopsyProcedure"> </a><a name="hcBiopsyProcedure"> </a><p><b>url</b>: <a href="ExampleScenario-BiopsyProcedure.html">Biopsy Procedure</a></p><p><b>version</b>: 0.0.8</p><p><b>name</b>: Biopsy Procedure</p><p><b>status</b>: Draft</p><p><b>date</b>: 2025-10-30 11:13:25+0000</p><p><b>publisher</b>: NHS North West Genomics</p><p><b>contact</b>: <a href="https://www.nwgenomics.nhs.uk/contact-us">https://www.nwgenomics.nhs.uk/contact-us</a></p><p><b>jurisdiction</b>: <span title="Codes:{urn:iso:std:iso:3166 GB}">United Kingdom of Great Britain and Northern Ireland</span></p><blockquote><p><b>actor</b></p><p><b>actorId</b>: nurse</p><p><b>type</b>: System</p><p><b>name</b>: Nurse</p><p><b>description</b>: </p><div><p>TODO</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: forms</p><p><b>type</b>: System</p><p><b>name</b>: Form Manager</p><p><b>description</b>: </p><div><p>This may be part of the EPR or be paper based</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: epr</p><p><b>type</b>: System</p><p><b>name</b>: Electronic Patient Record</p><p><b>description</b>: </p><div><p><a href="ActorDefinition-ProviderInformationSource.html">Provider Information Source</a></p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: patient</p><p><b>type</b>: System</p><p><b>name</b>: Patient/relative/carer</p><p><b>description</b>: </p><div><p>TODO</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: consultant</p><p><b>type</b>: System</p><p><b>name</b>: Consultant</p><p><b>description</b>: </p><div><p>TODO</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: laboratory</p><p><b>type</b>: System</p><p><b>name</b>: Diagnostic Testing</p><p><b>description</b>: </p><div><p>TODO</p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request1</p><p><b>resourceType</b>: Questionnaire</p><p><b>name</b>: Query Questionnaire</p><p><b>description</b>: </p><div><p>Query for Froms: <code>GET https://example.nhs.uk/FHIR/R4/Questionnaire</code></p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request2</p><p><b>resourceType</b>: Observation</p><p><b>name</b>: Query Observation and MedicationRequest</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request3</p><p><b>resourceType</b>: QuestionnaireResponse</p><p><b>name</b>: Create QuestionnaireResponse</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request4</p><p><b>resourceType</b>: Observation</p><p><b>name</b>: Create Observation and MedicationStatement from QuestionnaireResponse</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply1</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply3</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request5</p><p><b>resourceType</b>: Procedure</p><p><b>name</b>: Update Procedure -Biopsy</p><blockquote><p><b>version</b></p><p><b>Extension Definition for ExampleScenario.instance.version.title for Version 5.0</b>: Procedure Liver Biopsy</p><p><b>Extension Definition for ExampleScenario.instance.version.content for Version 5.0</b>: <a href="Procedure-13240a3b-d1db-4f1a-ad7d-b19f23967060.html">Procedure Biopsy of liver</a></p><p><b>versionId</b>: 1</p></blockquote></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request6</p><p><b>resourceType</b>: Specimen</p><p><b>name</b>: Update Specimen</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request7</p><p><b>resourceType</b>: Specimen</p><p><b>name</b>: Update Specimen with tracking number</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply5</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply6</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply7</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request8</p><p><b>resourceType</b>: Observation</p><p><b>name</b>: Create Observation - Vital Signs</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request9</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Create Disharge Letter</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply8</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply9</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Admission</p><p><b>description</b>: </p><div><p>Admit Patient. The process roughly follows <a href="https://build.fhir.org/ig/HL7/sdc">FHIR Structured Data Capture</a></p>
</div><p><b>preConditions</b>: </p><div><p>Test Order has been created (<a href="ExampleScenario-GenomicTestOrderProcess.html">Genomic Test Order Process</a>)</p>
</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: search-type</p><p><b>name</b>: Select Admission Forms</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: forms</p><p><b>description</b>: </p><div><p>This may be paper based</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request1</td></tr></table><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Reply1</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 2</p><p><b>type</b>: create</p><p><b>name</b>: Pre-populate Admission Form</p><p><b>initiator</b>: forms</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>If using electronic forms and their is a connection to an EPR or Health Information Exchange - the forms may be pre-populated</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request2</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 3</p><p><b>type</b>: read</p><p><b>name</b>: Complete Admission Form. </p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: patient</p><p><b>description</b>: </p><div><p>This includes enquiring about the patients medical history, such as conditions and medications. This also includes taking the patient vital signs - device data may be automatically uploaded into the EPR.</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request3</td></tr></table><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Reply3</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 4</p><p><b>type</b>: create</p><p><b>name</b>: Complete Admission Form. </p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: forms</p><p><b>description</b>: </p><div><p>Enter answers to questions in the forms. The end of this process is likely to be signalled via a <strong>IHE Patient Administration</strong> HL7 v2 ADT Admission event.</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request4</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Perform Biopsy</p><p><b>description</b>: </p><div><p>Perform Biopsy Procedure</p>
</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 5</p><p><b>type</b>: create</p><p><b>name</b>: Document Procedure - Record procedure details</p><p><b>initiator</b>: consultant</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>TODO</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request5</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 6</p><p><b>type</b>: update</p><p><b>name</b>: Document Procedure - Update specimen details</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>Ideally the updated specimen record should result in an update to the original order.</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request6</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 7</p><p><b>type</b>: create</p><p><b>name</b>: Send specimen</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: laboratory</p><p><b>description</b>: </p><div><p>If the specimen is being sent via a courier, then the specimen record should be updated with a tracking id</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request7</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Monitor and Discharge Patient</p><p><b>description</b>: </p><div><p>Monitor patient post procedure and Discharge Patient</p>
</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 8</p><p><b>type</b>: update</p><p><b>name</b>: Monitor Patient - Update specimen details</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>This probably includes taking of vital signs to ensure the patient is stable</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request8</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 9</p><p><b>type</b>: update</p><p><b>name</b>: Discharge Patient</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>This includes a <strong>IHE Patient Administration</strong> - HL7 v2 ADT Discharge event and may include clinical notes</p>
</div><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>Request9</td></tr></table></blockquote></blockquote></blockquote></div>
  </text>
  <url
       value="https://fhir.nwgenomics.nhs.uk/ExampleScenario/BiopsyProcedure"/>
  <version value="0.0.8"/>
  <name value="Biopsy Procedure"/>
  <status value="draft"/>
  <date value="2025-10-30T11:13:25+00:00"/>
  <publisher value="NHS North West Genomics"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.nwgenomics.nhs.uk/contact-us"/>
    </telecom>
  </contact>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="GB"/>
      <display value="United Kingdom of Great Britain and Northern Ireland"/>
    </coding>
  </jurisdiction>
  <actor>
    <actorId value="nurse"/>
    <type value="entity"/>
    <name value="Nurse"/>
    <description value="TODO"/>
  </actor>
  <actor>
    <actorId value="forms"/>
    <type value="entity"/>
    <name value="Form Manager"/>
    <description value="This may be part of the EPR or be paper based"/>
  </actor>
  <actor>
    <actorId value="epr"/>
    <type value="entity"/>
    <name value="Electronic Patient Record"/>
    <description
                 value=" [Provider Information Source](ActorDefinition-ProviderInformationSource.html) "/>
  </actor>
  <actor>
    <actorId value="patient"/>
    <type value="entity"/>
    <name value="Patient/relative/carer"/>
    <description value="TODO"/>
  </actor>
  <actor>
    <actorId value="consultant"/>
    <type value="entity"/>
    <name value="Consultant"/>
    <description value="TODO"/>
  </actor>
  <actor>
    <actorId value="laboratory"/>
    <type value="entity"/>
    <name value="Diagnostic Testing"/>
    <description value="TODO"/>
  </actor>
  <instance>
    <resourceId value="Request1"/>
    <resourceType value="Questionnaire"/>
    <name value="Query Questionnaire"/>
    <description
                 value="Query for Froms: `GET https://example.nhs.uk/FHIR/R4/Questionnaire`"/>
  </instance>
  <instance>
    <resourceId value="Request2"/>
    <resourceType value="Observation"/>
    <name value="Query Observation and MedicationRequest"/>
  </instance>
  <instance>
    <resourceId value="Request3"/>
    <resourceType value="QuestionnaireResponse"/>
    <name value="Create QuestionnaireResponse"/>
  </instance>
  <instance>
    <resourceId value="Request4"/>
    <resourceType value="Observation"/>
    <name
          value="Create Observation and MedicationStatement from QuestionnaireResponse"/>
  </instance>
  <instance>
    <resourceId value="Reply1"/>
    <resourceType value="Binary"/>
    <name value="Dummy"/>
  </instance>
  <instance>
    <resourceId value="Reply3"/>
    <resourceType value="Binary"/>
    <name value="Dummy"/>
  </instance>
  <instance>
    <resourceId value="Request5"/>
    <resourceType value="Procedure"/>
    <name value="Update Procedure -Biopsy"/>
    <version>
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.title">
        <valueString value="Procedure Liver Biopsy"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.content">
        <valueReference>🔗 
          <reference value="Procedure/13240a3b-d1db-4f1a-ad7d-b19f23967060"/>
        </valueReference>
      </extension>
      <versionId value="1"/>
    </version>
  </instance>
  <instance>
    <resourceId value="Request6"/>
    <resourceType value="Specimen"/>
    <name value="Update Specimen"/>
  </instance>
  <instance>
    <resourceId value="Request7"/>
    <resourceType value="Specimen"/>
    <name value="Update Specimen with tracking number"/>
  </instance>
  <instance>
    <resourceId value="Reply5"/>
    <resourceType value="Binary"/>
    <name value="Dummy"/>
  </instance>
  <instance>
    <resourceId value="Reply6"/>
    <resourceType value="Binary"/>
    <name value="Dummy"/>
  </instance>
  <instance>
    <resourceId value="Reply7"/>
    <resourceType value="Binary"/>
    <name value="Dummy"/>
  </instance>
  <instance>
    <resourceId value="Request8"/>
    <resourceType value="Observation"/>
    <name value="Create Observation - Vital Signs"/>
  </instance>
  <instance>
    <resourceId value="Request9"/>
    <resourceType value="Binary"/>
    <name value="Create Disharge Letter"/>
  </instance>
  <instance>
    <resourceId value="Reply8"/>
    <resourceType value="Binary"/>
    <name value="Dummy"/>
  </instance>
  <instance>
    <resourceId value="Reply9"/>
    <resourceType value="Binary"/>
    <name value="Dummy"/>
  </instance>
  <process>
    <title value="Admission"/>
    <description
                 value="Admit Patient. The process roughly follows [FHIR Structured Data Capture](https://build.fhir.org/ig/HL7/sdc)"/>
    <preConditions
                   value="Test Order has been created ([Genomic Test Order Process](ExampleScenario-GenomicTestOrderProcess.html))"/>
    <step>
      <operation>
        <number value="1"/>
        <type value="search-type"/>
        <name value="Select Admission Forms"/>
        <initiator value="nurse"/>
        <receiver value="forms"/>
        <description value="This may be paper based"/>
        <request>
          <resourceId value="Request1"/>
        </request>
        <response>
          <resourceId value="Reply1"/>
        </response>
      </operation>
    </step>
    <step>
      <operation>
        <number value="2"/>
        <type value="create"/>
        <name value="Pre-populate Admission Form"/>
        <initiator value="forms"/>
        <receiver value="epr"/>
        <description
                     value="If using electronic forms and their is a connection to an EPR or Health Information Exchange - the forms may be pre-populated "/>
        <request>
          <resourceId value="Request2"/>
        </request>
      </operation>
    </step>
    <step>
      <operation>
        <number value="3"/>
        <type value="read"/>
        <name value="Complete Admission Form. "/>
        <initiator value="nurse"/>
        <receiver value="patient"/>
        <description
                     value="This includes enquiring about the patients medical history, such as conditions and medications. This also includes taking the patient vital signs - device data may be automatically uploaded into the EPR. "/>
        <request>
          <resourceId value="Request3"/>
        </request>
        <response>
          <resourceId value="Reply3"/>
        </response>
      </operation>
    </step>
    <step>
      <operation>
        <number value="4"/>
        <type value="create"/>
        <name value="Complete Admission Form. "/>
        <initiator value="nurse"/>
        <receiver value="forms"/>
        <description
                     value="Enter answers to questions in the forms. The end of this process is likely to be signalled via a **IHE Patient Administration** HL7 v2 ADT Admission event. "/>
        <request>
          <resourceId value="Request4"/>
        </request>
      </operation>
    </step>
  </process>
  <process>
    <title value="Perform Biopsy"/>
    <description value="Perform Biopsy Procedure"/>
    <step>
      <operation>
        <number value="5"/>
        <type value="create"/>
        <name value="Document Procedure - Record procedure details"/>
        <initiator value="consultant"/>
        <receiver value="epr"/>
        <description value="TODO"/>
        <request>
          <resourceId value="Request5"/>
        </request>
      </operation>
    </step>
    <step>
      <operation>
        <number value="6"/>
        <type value="update"/>
        <name value="Document Procedure - Update specimen details"/>
        <initiator value="nurse"/>
        <receiver value="epr"/>
        <description
                     value="Ideally the updated specimen record should result in an update to the original order.  "/>
        <request>
          <resourceId value="Request6"/>
        </request>
      </operation>
    </step>
    <step>
      <operation>
        <number value="7"/>
        <type value="create"/>
        <name value="Send specimen"/>
        <initiator value="nurse"/>
        <receiver value="laboratory"/>
        <description
                     value="If the specimen is being sent via a courier, then the specimen record should be updated with a tracking id "/>
        <request>
          <resourceId value="Request7"/>
        </request>
      </operation>
    </step>
  </process>
  <process>
    <title value="Monitor and Discharge Patient"/>
    <description
                 value="Monitor patient post procedure and Discharge Patient"/>
    <step>
      <operation>
        <number value="8"/>
        <type value="update"/>
        <name value="Monitor Patient - Update specimen details"/>
        <initiator value="nurse"/>
        <receiver value="epr"/>
        <description
                     value="This probably includes taking of vital signs to ensure the patient is stable "/>
        <request>
          <resourceId value="Request8"/>
        </request>
      </operation>
    </step>
    <step>
      <operation>
        <number value="9"/>
        <type value="update"/>
        <name value="Discharge Patient"/>
        <initiator value="nurse"/>
        <receiver value="epr"/>
        <description
                     value="This includes a **IHE Patient Administration** - HL7 v2 ADT Discharge event and may include clinical notes"/>
        <request>
          <resourceId value="Request9"/>
        </request>
      </operation>
    </step>
  </process>
</ExampleScenario>