Genomic Test Order Process including order entry and transmission of the order

NHS North West Genomics
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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

ExampleScenario: Genomic Test Order Process including order entry and transmission of the order

Official URL: https://fhir.nwgenomics.nhs.uk/ExampleScenario/GenomicTestOrderProcess				Version: 0.0.8
Draft as of 2025-10-30				Computable Name: Genomic Test Order

Actors

Name	Type	Description
Order Placer	System	Order Placer
Form Manager	System	This may be part of the EPR or be paper based
Electronic Patient Record	System	NHS Trust Provider Information Source
Trust Integration Engine	System	Provider Information Source
Regional Integration Engine	System	Provider Information Source
Order Filler	System	Order Filler
Regional Clinical Data Repository	System	Clinical Data Repository

Diagram

Processes

Process: Complete Genomic Test Order Form

Creates Test Order Form. Details on what questions and answers should be in the form are listed here Questionnaire: North West Genomics Test Order. This is also designed to work with HL7 Structured Data Capture, however in most cases this form based data capture be part of the EPR.

Step	Name	Description	Initiator	Receiver	Request	Response
1	Select Genomic Test Order Form - search-type (Details: FHIR Restful Interactions code search-type)	This may be part of the EPR and not implemented in HL7 FHIR. If not using FHIR, the clinical coding and valuesets in the FHIR Questionnaire should be implemented in the EPR Order Form	Order Placer	Form Manager	Search for Order Genomic Test Order Form	Search results
2	Pre-populate Order Form - create (Details: FHIR Restful Interactions code create)	If using electronic forms and their is a connection to an EPR or Health Information Exchange - the forms may be pre-populated	Form Manager	Electronic Patient Record	Pre-Populate form request
4	Complete Genomic Test Order Form. - create (Details: FHIR Restful Interactions code create)	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.	Order Placer	Electronic Patient Record	Completed Form

Process: Submit Genomic Test Order Form

The order is sent from the EPR using HL7 ORM_O21 and this is sent to the Order Filler/Laboratory Information Management System (LIMS) via middleware

Step	Name	Description	Initiator	Receiver	Request
5	Send Laboratory Order ORM_O01 v2 - create (Details: FHIR Restful Interactions code create)	In NHS Trusts will this will often be HL7 v2 ORM_O01 from the EPR, the region is using HL7 v2/FHIR OML_O21 which may involve some message transformation especially around v2 SPM/FHIR Specimen. Note: the region is using a common (canonical) data model for both v2 and FHIR. Most coded questions and answer should be be supplied in v2 OBX segments which have a simple transform to FHIR Observations.	Electronic Patient Record	Trust Integration Engine	HL7 v2 ORM_O01 - supplier
6	Send Laboratory Order O21 FHIR - create (Details: FHIR Restful Interactions code create)	Message routing is done using the FHIR Message, this is where future routing to other GMSA/GLH will be performed using the NHS England Genomic Order Management Service.	Trust Integration Engine	Regional Integration Engine	HL7 FHIR Message O21 - regional
7	Send Laboratory Order OML_O21 v2 - create (Details: FHIR Restful Interactions code create)	The FHIR Message is transformed by the RIE into a v2 Message	Regional Integration Engine	Order Filler	HL7 v2 OML_O21 - regional

Process: Send Order to Regional Genomic CDR

The order is sent to the regional Clinical Data Repository which shares the order using FHIR RESTful readonly APIs

Step	Name	Description	Initiator	Receiver	Request	Response
9	Send Laboratory Order O21 FHIR - create (Details: FHIR Restful Interactions code create)	TODO	Regional Integration Engine	Regional Clinical Data Repository	HL7 FHIR Message O21 - regional

Process: Collect Sample

This process is not required if the sample has already been collected (and this is a reflex order). For an example process see ExampleScenario: Biopsy Procedure.

Step	Name	Description	Initiator	Receiver	Request	Response
8	Collect sample - create (Details: FHIR Restful Interactions code create)	See Biopsy and Blood scenarios for more details	Regional Integration Engine	Order Filler	Collect Sample

Process: Perform Genomic Tests

See ExampleScenario: Genomic Report Process

Step	Name	Description	Initiator	Receiver	Request	Response

Instances

Name	Type	Content	Description
Search for Order Genomic Test Order Form	Binary		Query for Froms: `GET https://example.nhs.uk/FHIR/R4/Questionnaire?id=GenomicTestOrder`
Search results	Bundle
Search Results	Bundle	here
Pre-Populate form request	Binary
Completed Form	QuestionnaireResponse
HL7 v2 ORM_O01 - supplier	Binary
HL7 FHIR Message O21 - regional	Bundle		This is equivalent to HL7 v2.5 OML_O21, it may be advisable to use this message in the previous step to reduce transforms.
HL7 FHIR Message O21	Bundle	here	This is equivalent to HL7 v2.5 OML_O21, it may be advisable to use this message in the previous step to reduce transforms.
HL7 v2 OML_O21 - regional	Binary		Regional HL7 v2 OML_O21
Collect Sample	Binary
HL7 FHIR Message O21 - regional	Bundle		TODO
HL7 FHIR Message O21	Bundle	here	TODO

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