Stream: implementers
Topic: Storing in FHIR the PDF Result from HL7 message
Santosh Jami (Dec 02 2021 at 06:58):
EMR System placed a LabOrder for 5 different tests (Covid-19, HIV, HEPC, CMP and Creatinine).
Am Storing the LabOrder in FHIR as ServiceRequest resource.
LabSystem returned the 5 results in the HL7 ORU message, 5 groups of ORC / OBR / OBX .
The Results PDF is a summary of all 5 results, is sent across in custom Z segment.
On the FHIR side, I am storing each LabTest as DiagnosticReport.
Regarding the Results PDF - I plan to store it as DocumentReference.
Now, is it right to store this DocumentReference in association with ServiceRequest or should it be referenced at all 5 individual diagnostic reports?
René Spronk (Dec 02 2021 at 07:52):
If this was one single LabOrder, then why have 5 DiagnosticReports ? I'd go for one DiagnosticReport if possible.
Santosh Jami (Dec 02 2021 at 08:00):
@René Spronk - it is LabOrder Panel, that consists of 5 Lab Tests.
And each LabTest Result is a DiagnosticReport by itself.
René Spronk (Dec 02 2021 at 08:03):
Even more reason to create only one DiagnosticReport, which references 5 Observation resources. DiagnosticReport.presentedForm can be used to send the PDF.
Santosh Jami (Dec 02 2021 at 08:16):
That was what my initial approach was, to create the DiagnosticReport, map the IndividualTests as Observations and the Analytes / Components under the Individual Test as Observation.Component
- each OBR becomes Observation.
- Each OBX under the OBR becomes Observation.Component
But after reviewing the HL7 to FHIR converters, I observed that each OBR was treated as a separate DiagnosticReport, and each OBX was treated as Observation resource.
So, this caused me a rethink. I am little confused as to which is the suggested mapping.
Sample HL7 I am referring to is attached here (no PHI in there HL7_ORU_Task-2_Deidentified.txt )
René Spronk (Dec 02 2021 at 09:02):
AFAIK there's no single best practice as to how to do this. But then again, I'm a trainer by profession, not a lab specialist (although I know a fair bit about lab workflows). #Orders and Observation WG may be the best stream to consult the lab pundits.
The fact that you have 1 panel for these 5 tests, and that there is one PDF report for all 5 tests, are both clear indicators that your use case is probably best served by using 1 DiagnosticReport.
Santosh Jami (Dec 02 2021 at 10:07):
Will post it there. Thanks for your inputs as always @René Spronk
Michele Mottini (Dec 02 2021 at 14:52):
Seconding what Rene' wrote: this is what we are seeing and generating for panels, one DiagnosticReport with 5 observations
Last updated: Apr 12 2022 at 19:14 UTC
