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November 20-22, Amsterdam | @HL7 @FirelyTeam | #fhirdevdays | www.devdays.com
Laboratory Test Ordering on FHIR
Aleksandr Ivanov
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How can someone order lab tests in Russia?
• Different types of consumers
• Medical organizations
• Labs
• People who would like to make a lab test without a referral
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What do customers want?
• Catalog of available lab tests
• Specimen types for tests
• Which observations will be returned for lab tests?
• Estimated time of accomplishment (delays)
• Observations required for correct reference ranges
• Guidelines about preanalytics calculation
• Make requests
• Receive results
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What can be expressed in HL7 FHIR R4?
Requirement FHIR Resources
Catalog Composition, CatalogEntry, PlanDefinition
Specimens for lab tests ActivityDefintion, SpecimenDefinition
Observation for lab tests ActivityDefintion, ObservationDefinition
Estimated time of accomplishment ?
Observations required for correct reference ranges
ActivityDefintion, ObservationDefinition
Guidelines on preanalytics calculation ?
Make requests ServiceRequest, Task, Specimen, Observation, Patient
Receive results DiagnosticReport, Observation
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Catalog
• Catalog resources are not mature enough in R4
• A lot of interest from different organizations in different countries:
• Phast (France)
• University of Utah
• Quest Diagnostics (US laboratory)
• LabCorp (US laboratory)
• Medlinx (Russia)
• Helix (Russian laboratory)
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Catalog
LOINC 34555-3
Creatinine 24H renal clearance panel Preferred: Serum, yellow cap
minimum volume …
Venous blood specimen
LOINC 2164-2
mL/min
Creatinine renal
clearance in 24h
Alternate: Plasma, green cap
minimum volume …
LOINC 2160-0
mg/dL
Creatinine on
serum/ plasma
LOINC 3167-4
Volume of 24H urine
LOINC 13362-9
Collection duration
input observations
LOINC 2162-6
Creatinine [Mass/time] in 24-hour Urine
Creatinine / 24H urine
…
24h urine
specimen container …
Capillary blood specimen
XOR
LOINC 3167-4
mL
24H urine
volume LOINC 13362-9 h
urine collection
duration
LOINC 65634-8
24h urine creatinine
panel
output observations output observations
LOINC 2160-0
Serum creatinine
test
Created by OrderCatalog WG
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Catalog
Created by OrderCatalog WG
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Sequence chart
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Estimated time of accomplishment
• No standard way to do
• We use two extensions for CatalogEntry
• https://api.medlinx.online/extension/eta-status
• https://api.medlinx.online/extension/eta-delay-duration
Value Description
available Lab test available for order
delayed Lab test available for order but will be delayed
stopped Lab test can't be performed by the laboratory
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Estimated time of accomplishment in HL7 FHIR R5
• CatalogEntry
• estimatedDutaion filed
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Preanalytics
• What do we call preanalytics phase of lab testing:
• how to handle specimens
• which specimens can be taken into one container
• The laboratory provides the textbook with guidelines
• We decided to provide API
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Preanalytics
• What do we call preanalytics phase of lab testing:
• how to handle specimens
• which specimens can be taken into the same container
• The laboratory provides the textbook with guidelines
• We decided to provide API
![Page 13: Laboratory Test Ordering on FHIR - FHIR DevDays · Catalog LOINC 34555 -3 Creatinine 24H renal clearance panel Preferred: Serum, yellow cap minimum À}oµu Y Venous blood specimen](https://reader036.vdocuments.us/reader036/viewer/2022062303/5fbf262f76855f1e894d25be/html5/thumbnails/13.jpg)
Order lab tests
• Create separate resources
• Basic FHIR workflow
• Not easy for producer and consumer
• Create a bundle with all resources
• Unusual FHIR workflow
• Easy for workflow participants to exchange.
• How to handle the status of requests inside the bundle?
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Order lab tests
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Lab test results
• We can't use separate Diagnostic reports and Observations in our workflow.
• Documents
• We provide two ways to receive results
• Polling
• Notifications
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Summary
• We can build almost all types of interactions for lab testing with HL7 FHIR R4
• Some extensions can be part a of the standard in next release
• A lot of resources are not mature, use them on your own risk
• Sometimes it is easier to use custom workflow for API.
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