Stream: Orders and Observation WG
Topic: DiagnosticReport scope
Elliot Silver (Jan 24 2019 at 21:57):
@Eric Haas , I see that you were discussing the boundaries of DiagnosticReport on today's call. Some thoughts:
I agree that the distinction between DiagnosticReport and Composition is not how structured the report is. I think DR should support use cases for broad variation in "structured-ness". I think a Composition might be a useful to way to structure the content of the report though. Similarly, DocRef may be a way to store the presented form.
Imaging results in both observations and reports, and the two are not the same. There are specific measurements, volumes, etc. that should be observations. Even "a mass was observer in the ..." or "No evidence of ..." are observations. Those are individual and stand alone. Separately, the DiagnosticReport would include narrative about the procedure performed, relevant clinical history, relevant observations, and conclusions. The DR might reference the individual observations, and I expect both to be present (at least in a fully FHIR environment).
Andrea Pitkus, PhD, MLS(ASCP)CM, CSM (Jan 28 2019 at 17:01):
With @Kevin Power DR has been discussed on CG calls. Concur with some of Elliott's points about differences in reports from laboratory vs imaging. the observations (lab results) can be reported individually as FHIR observations and combined together into a DR of record (lab report of record)
CG's been talking about the DR structure and sections. Also different performing laboratories or sections may issue their own DR (and have the required structure/data elements, say for a hematopathology, flow cytometry or cytogenetics report), while other laboratories may have a single integrated report with each laboratory's results reported as a section in the DR with a single diagnosis issued by the pathologist for what the laboratory results indicate. (also the focus of my dissertation on diagnostic discordance with the separate reports.)
Eric Haas (Jan 28 2019 at 17:20):
@Elliot Silver Thanks for you comments. I want to shift away from simply describing boundaries based on "what this structure can represent vs that structure" to real life use cases and I think your second paragraph gets closer to that. I'm still not sure how a composition led bundle fits into this picture when we strip away what it can do based on it structure (since It can lump and organize any N resources together and overlaps with all 'aggregating' resource like DR). ( this is the same issue with DocRef - which based on it structure overlaps any resource with an Attachment ). We need to pow wow with SD on this. @Andrea Pitkus, PhD, MLS(ASCP)CM, CSM we have several extension for DR to handle complex reporting and would love to see some examples of these in use can you provide some?
Andrea Pitkus, PhD, MLS(ASCP)CM, CSM (Jan 28 2019 at 18:14):
@Eric Haas Totally agree these need to be modeled with reports folks are using today. @Kevin Power and CG discussed similarly today with CG.
Personally, in working through some common lab examples in Clinicians on FHIR, haven't been able to complete the full order to result from EHR to LIS and back "trip" with FHIR yet to demonstrate it can be implemented correctly. If folks are aware of cases, do want to know.
Here are some bone marrow biopsy reports that can be used as examples:
1. Normal Hematology Consult with single integrated report showing results of ancillary studies : https://www.mayocliniclabs.com/test-updates/attachment.php?id=52148 @Kevin Power the CBC result done by the clinical laboratory (which is reported separately in their LIS & EHR) is pulled into the BM Report under the microscopic section/header. Is this what you were envisioning as discussed this am?
2. Flow Cytometry for suspected hematologic malignancy, namely MDS (myelodysplastic Syndrome) : https://www.mayocliniclabs.com/test-updates/attachment.php?id=41830 (May be ordered at the same time as the hematology Consult on a patient with suspected MDS) . It should be noted, that one section includes a MDS Panel that was performed. The test info indicates 2 MDS panels are typically performed: https://www.mayocliniclabs.com/test-catalog/Overview/63414 Also indicates the test shouldn't be used for interpretation alone, but in conjunction with other related test/results such as genetics and molecular.
3. Chromosome Analysis of Hematologic Disorders, Bone Marrow: https://www.mayocliniclabs.com/test-updates/attachment.php?id=44727 Here's the genetic testing on bone marrow for suspected MDS that could be performed and it's abnormal report. also: https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/35245 This report also includes reference to previous results, which is vital for understanding treatment effects.
I did rotate through some of Mayo's laboratories as part of my clinicals and spent a summer "diagnosing bone marrows" at the UMN under a pathologist now at Mayo and when Dick Brunning was there, who is listed as one of the reference authors for the WHO Diagnostic criteria. be happy to address any laboratory workflow or data questions resulting in the diagnostic report. @John David Larkin Nolen (O&O co chair)can also share his hematopathology reporting practices too....
Here's an example of LabCorp's bone marrow biopsy structure:
1. https://www.labcorp.com/test-menu/21256/bone-marrow-aspiration-and-biopsy
Folks on O&O can go into more detail as they unfortunately, don't list an abnormal report for this item.
2. Their Bone Marrow Flow Cytometry order: https://www.labcorp.com/test-menu/30356/leukemia-lymphoma-immunophenotyping-profile Sample normal & abnormal reports: https://www.labcorp.com/sites/testmenu/files/480260.pdf
It gives you an idea of how reports can be structured and data communicated in the Diagnostic Report of Record. However, these are pdf reports and not completely discrete and codified, which is one of the goals from an interoperability perspective.
Eric Haas (Jan 28 2019 at 18:18):
TY!
Andrea Pitkus, PhD, MLS(ASCP)CM, CSM (Jan 29 2019 at 17:01):
YW! CG will also be sharing some report examples.
Last updated: Apr 12 2022 at 19:14 UTC
