Stream: implementers
Topic: DiagnosticReport - Composition/Bundle boundaries
Robin Bosman (Oct 07 2020 at 11:48):
I am investigating the DiagnosticReport resource to express laboratory results. I was also thinking about guidelines how to use this in an architecture that might not use the FHIR REST API initially but might have to use existing architectures and only use FHIR for the payload. That led to thinking about expressing DiagnosticReport using the FHIR Document structure.
Following the FHIR Document rules, the Composition resource required by the FHIR Document approach would only point to the DiagnosticReport resource.
On some level, this feels a bit redundant as actually the structure - normally governed by the Composition resource in a document - is now taken over by the DiagnosticReport - is that a correct interpretation?
When looking into the extensions that are available for the DiagnosticReport: there are (among others) 'addendumOf,' 'extends' and 'replaces'. Those confused me a little bit because they seem to point to a compatibility with a report expressed as CDA -> I would expect CDA compatibility would be done using Composition.
Maybe I am overthinking this: on the DiagnosticReport page there are some nice examples using a collection bundle to express the DiagnosticReport. Maybe that would be a good enough solution when exchanging a report in an otherwise non-FHIR architecture and forget about the document structure or is that a dangerous assumption?
Lloyd McKenzie (Oct 07 2020 at 13:02):
There is a degree of overlap between Composition and DiagnosticReport - both are 'organizers'. However, Composition can organize anything and is focused on human presentation. DiagnosticReport is focused on summarizing and reporting out a particular result. The responsible work group is discussing how/whether to reduce some of the redundancy. At the moment though, you'll need both. You cannot have a FHIR document that doesn't start with Composition.
Robin Bosman (Oct 07 2020 at 14:26):
Tx - this helps clarifying!
Hans Buitendijk (Oct 14 2020 at 15:04):
Note that there is a proposal that is in JIRA (https://jira.hl7.org/browse/FHIR-29258) to clarify the distinction between DiagnosticReport and Composition further. DiagnosticReport is effectively the set of results (one or more Observations) in response to a request for a diagnostic service (or set of services) while the Composition can provide further structure to that set of results. Currently there is no ability within DiagnosticReport to organize the results in sections or sequence or otherwise as can be done in Composition. Rather than repeating that capability in DiagnosticReport, the proposal is that Composition is used for that where needed, e.g., when a structured document format is required to represent the content of DiagnosticReport. An update to DiagnosticReport to allow for .presentedForm to either reflect an attachment or a Composition would link them together.
Lin Zhang (Oct 14 2020 at 15:40):
But Observation(s) referenced could be used to construct the nested sections. For example:
http://hl7.org/fhir/diagnosticreport-example-ghp.xml.html
Robin Bosman (Oct 16 2020 at 16:07):
Yes indeed, I thought the way the examples with nesting are now constructed, specifically these http://hl7.org/fhir/diagnosticreport-examples.html#10.3.7.1.1 actually demonstrate a very pragmatic way to model complex reports (as opposed for example how it is done in CDA. )
Robin Bosman (Oct 16 2020 at 16:10):
@Jose Costa Teixeira
Hans Buitendijk (Oct 20 2020 at 18:25):
Correct, but nesting is not the same as sections and sequence.
Last updated: Apr 12 2022 at 19:14 UTC
