England Pathology and Laboratory Medicine (PaLM) Technical Framework
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FHIR Resources

The FHIR profiles in this guide describe one laboratory content model, used in FHIR Messages (the HL7 v2 equivalent) and FHIR Documents (the NHS England national route).

Model

erDiagram
    ServiceRequest ||--|| Patient : subject
    ServiceRequest }o--|| PractitionerRole : requester
    PractitionerRole }o--|| Practitioner : practitioner
    PractitionerRole }o--|| Organization : organization
    ServiceRequest }o--o{ Specimen : specimen
    DiagnosticReport }o--o{ ServiceRequest : basedOn
    DiagnosticReport ||--|| Patient : subject
    DiagnosticReport }o--|| Organization : performer
    DiagnosticReport ||--o{ Observation : "result (test group or single test)"
    Observation ||--o{ Observation : "hasMember (test group)"
    DiagnosticReport }o--o{ Specimen : specimen
    Observation }o--|| Organization : performer
    Specimen ||--|| Patient : subject
    Composition ||--|| DiagnosticReport : "section.entry"
    Provenance }o--|| Composition : target

Profiles

Profile Resource Parent HL7 v2 Notes
Patient Patient HL7 Europe patient-eu-core PID From the NW GMSA IG
Laboratory Order ServiceRequest HL7 Europe ServiceRequest-eu-lab ORC, OBR (OML), TQ1  
Specimen Specimen HL7 Europe Specimen-eu-lab SPM  
Laboratory Report DiagnosticReport HL7 Europe diagnosticReport-eu-core the OBRs of one report (sharing OBR-3) One per report. See below
Laboratory Result Observation HL7 Europe Observation-resultslab-eu-lab OBX; a test group is the OBR A test group (organizer) has hasMember
Organization Organization HL7 Europe organization-eu-core XON, MSH-4 / MSH-6 ODS code
Practitioner Practitioner HL7 Europe practitioner-eu-core XCN GMC / NMC / HCPC / GMP
PractitionerRole PractitionerRole HL7 Europe practitionerRole-eu-core ORC-12 + ORC-21, PV1-8 + PV1-3  
Laboratory Report Composition Composition HL7 Europe Composition-eu-lab - Document only
Laboratory Report Provenance Provenance Provenance - Document only (NHS England)
Bundle - Laboratory Report Document Bundle HL7 Europe Bundle-eu-lab - NHS England API
MessageHeader MessageHeader MessageHeader MSH, MSA From the NW GMSA IG
Bundle - FHIR Messaging Bundle Bundle the message From the NW GMSA IG

Identifier data types (NHS Identifier, Medical Record Number, Organisation Code, Order Identifier, Report Identifier, Accession Identifier and others) are copied from the NW GMSA IG, so identifiers are filled in the same way across the NW GMSA, Imaging, Cancer Pathology Report and this guide.

Why These Parents

  • HL7 Europe Laboratory Report is the base of the NHS England Pathology FHIR IG (its Composition, DiagnosticReport and ServiceRequest profiles are EU Laboratory profiles), so this guide uses it too
  • DiagnosticReport - HL7 Europe DiagnosticReport-eu-lab requires the R5 DiagnosticReport.composition extension, so every report must belong to a Composition. That suits a document but not a FHIR Message (or a RESTful DiagnosticReport), so the Laboratory Report is derived from EU Core diagnosticReport-eu-core, as the NW GMSA IG's report is. In a document the report SHALL also meet DiagnosticReport-eu-lab - see the document example. NHS England uses a locally amended DiagnosticReport-eu-lab (2.0.0-nhs-fix), probably for a similar reason (To confirm)
  • No UK Core dependency - HL7 Europe Laboratory restricts its references to HL7 Europe Core profiles (Patient, Practitioner, PractitionerRole, Organization), so this guide uses those. NHS England uses UK Core for Practitioner, PractitionerRole and Organization; the content (identifiers) is the same, but the meta.profile differs - see Pathology Laboratory Reporting API
Guide Relationship
NHS England Pathology FHIR IG The national FHIR Document for primary care. This guide aligns its Document profiles with it and adds the HL7 v2 and FHIR Message forms
HL7 Europe Laboratory Report Parent of most profiles
NW GMSA FHIR IG Same IHE LTW / ILW approach and HL7 v2 conventions, for genomics. Data types, Patient and messaging profiles are copied from it
Cancer Pathology Report Cellular pathology (out of scope here)
HL7 v2 to FHIR Basis of the mapping