England Pathology and Laboratory Medicine (PaLM) Technical Framework
0.1.0 - ci-build
England Pathology and Laboratory Medicine (PaLM) Technical Framework
0.1.0 - ci-build
England Pathology and Laboratory Medicine (PaLM) Technical Framework - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Order Results Management [LAB-3] - the Order Filler (LIMS) sends results to the Order Result Tracker (EPR, GP system, shared care record): preliminary, final and corrected results, and cancellations.
sequenceDiagram
participant OF as Order Filler<br/>LIMS
participant ORT as Order Result Tracker<br/>EPR / GP system
OF ->> ORT: ORU^R01 / FHIR Laboratory Result (R01)
ORT -->> OF: ACK^R01 (MSA-1 AA, AE, AR) / FHIR response (ok, transient-error, fatal-error)
| Segment | Optionality | Notes | FHIR |
|---|---|---|---|
| MSH | 1..1 | MSH SHALL NOT be used to derive patient, clinician or identifier information | MessageHeader |
| PATIENT_RESULT | 1..* | ||
| - PID | 1..1 | Patient | |
| - NTE | 0..* | Patient comments (clinical history) | Patient - not mapped (Open) |
| - PV1 | 0..1 | Requesting location (PV1-3) and clinician (PV1-8) - the place the report returns to | DiagnosticReport.encounter, ServiceRequest.requester |
| - ORDER_OBSERVATION | 1..* | One per test group or test. The OBRs sharing OBR-3 are one report | |
| – ORC | 0..1 | SHOULD be sent where there was an electronic order | Laboratory Order |
| – OBR | 1..1 | Laboratory Report (one per report) and, with several OBX, a test group Laboratory Result | |
| – NTE | 0..* | Report comment (NTE-2 = L) |
DiagnosticReport.conclusion |
| – TQ1 | 0..* | Priority of the original request | ServiceRequest.priority |
| – OBSERVATION | 1..* | ||
| — OBX | 1..1 | Laboratory Result, or DiagnosticReport.presentedForm for ED / RP |
|
| — NTE | 0..* | Result comment | Observation.note |
| – SPECIMEN | 0..* | ||
| — SPM | 1..1 | Specimen |
The overall report status is OBR-25. It SHALL be sent and SHALL be accurate.
Where a report has several OBRs, each carries the report status and it SHOULD be the same
on all of them (FHIR: the one DiagnosticReport's status; the test group Observation takes
its own OBR-25). OBX-11 is the status of the individual result. DHCW notes
receivers that use OBR-25 for the whole report and disregard OBX-11; senders
SHOULD therefore keep OBR-25 and OBX-11 consistent. See
v2-0123-to-diagnostic-report-status and
v2-0085-to-observation-status.
A corrected result is sent as a new ORU with the same Filler Order Number, OBR-25 = C
and the corrected OBX-11 = C. It replaces the earlier result (FHIR: update the
same DiagnosticReport and Observation - same identifiers - with status corrected).
A result sent for the wrong patient is withdrawn with OBX-11 = W (FHIR:
entered-in-error).
The FHIR equivalent is the Laboratory Result (R01)
message: a Bundle Message whose
MessageHeader has eventCoding v2-0003 R01 and
focus the Laboratory Report(s). More examples:
the NHS England examples as ORU^R01. ACK^R01
is a FHIR response message (MessageHeader.response). For the NHS England national
route the same content is a FHIR Document - see
NHS England Pathology Laboratory Reporting API.
The full blood count result for the LAB-1 example.
MSH|^~\&|LIMS|R0A|GPSYSTEM|A12345|20261103160530||ORU^R01^ORU_R01|LIMS-MSG-000987|P|2.5.1|||AL
PID|1||633^^^R0A^MR~9449305552^^^NHS^NH||CHISLETT^Octavia^^^Miss||20080920|F|||1 RAVENSFIELD GARDENS^^EPSOM^SURREY^KT19 0ST|||||||||||||||||||||01
PV1|1|O|^^^^^^^^Example Surgery^A12345|||||G1234567^GREEN^Alex^^^Dr^^^GMP^^^^DN
ORC|RE|GP-ORD-000123^GPSYSTEM|26H012345^LIMS|GP-REQ-000045^GPSYSTEM|CM||||20261103091000|||G1234567^GREEN^Alex^^^Dr^^^GMP^^^^DN|||||||||Example Surgery^^^^^^^^^A12345
OBR|1|GP-ORD-000123^GPSYSTEM|26H012345^LIMS|1022441000000101^FBC - full blood count^SCT|||20261103091500|||||||||G1234567^GREEN^Alex^^^Dr^^^GMP^^^^DN||||||20261103160500||HM|F|||||||7654321&HUGHES&Sam&&&Dr&&&GMC
NTE|1|L|Mild anaemia with low white cell count. Suggest repeat in 4 weeks.
OBX|1|NM|1022541000000102^Total white cell count^SCT^6690-2^Leukocytes [#/volume] in Blood by Automated count^LN||3.5|10*9/L^^UCUM|4.0-11.0|L|||F|||20261103091500|||||||||Manchester University NHS Foundation Trust^^^^^^^^^R0A
OBX|2|NM|1022431000000105^Haemoglobin estimation^SCT^718-7^Hemoglobin [Mass/volume] in Blood^LN||112|g/L^^UCUM|115-165|L|||F|||20261103091500|||||||||Manchester University NHS Foundation Trust^^^^^^^^^R0A
OBX|3|NM|1022651000000100^Platelet count^SCT^777-3^Platelets [#/volume] in Blood by Automated count^LN||250|10*9/L^^UCUM|150-400|N|||F|||20261103091500|||||||||Manchester University NHS Foundation Trust^^^^^^^^^R0A
OBX|4|NM|1022451000000103^Red blood cell count^SCT^789-8^Erythrocytes [#/volume] in Blood by Automated count^LN||4.20|10*12/L^^UCUM|3.80-5.80|N|||F|||20261103091500|||||||||Manchester University NHS Foundation Trust^^^^^^^^^R0A
OBX|5|NM|1022291000000105^Haematocrit^SCT^4544-3^Hematocrit [Volume Fraction] of Blood by Automated count^LN||0.38|L/L^^UCUM|0.37-0.47|N|||F|||20261103091500|||||||||Manchester University NHS Foundation Trust^^^^^^^^^R0A
OBX|6|NM|1022491000000106^Mean cell volume^SCT^787-2^MCV [Entitic mean volume] in Red Blood Cells by Automated count^LN||88|fL^^UCUM|80-100|N|||F|||20261103091500|||||||||Manchester University NHS Foundation Trust^^^^^^^^^R0A
OBX|7|NM|1022471000000107^Mean cell haemoglobin^SCT^785-6^MCH [Entitic mass] by Automated count^LN||29.0|pg^^UCUM|27.0-33.0|N|||F|||20261103091500|||||||||Manchester University NHS Foundation Trust^^^^^^^^^R0A
SPM|1|GP-SPC-000123&GPSYSTEM^26H012345&LIMS||119297000^Blood specimen^SCT|||||||||||||20261103091500|20261103134000
and its acknowledgement:
MSH|^~\&|GPSYSTEM|A12345|LIMS|R0A|20261103160532||ACK^R01^ACK|GP-MSG-000777|P|2.5.1
MSA|AA|LIMS-MSG-000987
FHIR equivalents: Bundle Message - Laboratory Result (R01) and Bundle Message - Acknowledgement. The segment by segment conversion is worked through on Mapping HL7 v2 and FHIR.