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NHS England Diagnostic Order Services

This page assesses the national NHS England services for diagnostic test orders and results - genomics, pathology and imaging - against the IHE laboratory (LTW) and radiology (SWF.b) workflows and the 360X transactions. A referral to a diagnostic service is the same order and report pattern as a referral to a clinical service. Referral services (eRS, BaRS, Transfer of Care, GP Connect, IM1, EPS) are assessed on NHS England Referral and Report Services.

References

• Genomic Order Management Service (FHIR) API (OpenAPI 3.0.6-beta, checked 2026-11-02) and FHIR Genomics Implementation Guide
• MNS - Genomic Order Management Event (genomic-order-event-1, private beta, last edited 18 August 2026, checked 2026-11-02)
• Pathology FHIR Implementation Guide 0.5.1 (released 09/09/2026, checked 2026-11-02)
• NW GMSA - Laboratory Testing Workflow - GOMS in the regional order workflow
• National Imaging Registry (NIR) API (0.43.0, checked 2026-11-02) and NIR service
• Enterprise Imaging - Radiology Scheduled Workflow (SWF.b)
• IHE Laboratory Testing Workflow (LTW)

Coverage of the Closed Loop

The 360X steps for test orders - the IHE profiles (see Order and Report Workflow Pattern) and the national services that implement part of them:

GOMS and Pathology FHIR each implement part of LTW nationally (genomic ordering and reporting; pathology reporting to GPs). No national radiology order service was found - radiology orders stay local (order comms to RIS, SWF.b) - To confirm. The NIR covers the sharing half - finding and retrieving reports and images after the loop has closed.

Genomic Order Management Service (GOMS)

GOMS is "the national service used to send electronic orders from NHS organisations to Genomic Services". It covers "genomics test ordering and reporting": clinicians "create requests for genomics tests", "track status updates to tests" and "retrieve interpretation reports"; laboratories "provide status updates on test progress" and "upload interpretation reports" (API specification 3.0.6-beta, in development).

Genomic Order Event (MNS)

GOMS publishes genomic-order-event-1 through the Multicast Notification Service (private beta). It is how the requester and the laboratory learn that something has changed, without polling:

• Notify, then read. The notification "does not include" the order, report or workflow data: the subscriber reads it from the GOMS FHIR API. The FHIR form is a history Bundle holding a Parameters resource with focus (the changed resource), timestamp, event-number, event-type and subject (the order, https://fhir.nhs.uk/Id/GMSOrder); a CloudEvents form is for internal subscribers only.
• Subscription filters by resource type, status (including taskStatus, taskBusinessStatus, taskCode) and organisation (requester, performer, Task owner ODS codes), so a laboratory or requester receives only its own orders. Delivery is by MESH or AWS SQS.
• This is the FHIR Subscription notify-then-fetch pattern (an id-only style notification). The Bundle shape looks like the R5 Subscriptions backport notification - To confirm conformance. It plays the role of the push messages in 360X: the event says "status changed", the API gives the state.

Assessment against the general standards:

• Aligned with FHIR Workflow. ServiceRequest + Task + DiagnosticReport is the same model as this guide's Referral Request and Referral Task, and matches IHE LTW (LAB-1 order, LAB-3 result). It is a good model for referrals to diagnostic services.
• Central store, not point to point. Both the placer and the filler write to one national record (the Unified Genomic Record), so status and reports are read (GET after an MNS genomic order event) rather than pushed as in 360X. A trust integration engine converts GOMS orders to the HL7 v2 the local LIMS expects - see NW GMSA LTW.
• Transactions, not FHIR Messages: the update is a REST transaction Bundle, so the event is implied by the resources - To confirm how cancellation and declined tests are represented (Task status values).

Pathology FHIR

The Pathology FHIR Implementation Guide (0.5.1, under active development) replaces PMIP EDIFACT (NHS003) pathology reports, which today go from laboratory middleware to the GP system over MESH. It covers reporting only, initially for tests requested by GP practices (blood sciences and microbiology).

Assessment against the general standards:

• Aligned. It is built on the HL7 Europe Laboratory Report guide - the same family as the HL7 Europe HDR used for reports here - and uses a FHIR Document, which is this guide's report pattern.
• Closes the report half of the loop only. There is no order status (accept, decline, cancel); the report carries the request identifiers so the GP system can match it. Error handling and the Acknowledgement Framework are "TBC".

National Imaging Registry (NIR)

The NIR "allows authorised systems to view a patient's imaging history, including examinations, diagnostic reports, and imaging studies for use in direct care". It is federated: "a consumer queries NIR once and then NIR forwards the query to participating imaging networks, returning an aggregated list of results" (API 0.43.0, in production (beta), checked 2026-11-02).

Assessment against the general standards:

• Aligned. XCA, XCA-I and XUA are the IHE cross-community document sharing profiles, and the planned MHD endpoint matches this guide's Document Sharing approach. It is the national example of sharing data by query, leaving messaging for the workflow - see Health Data API.
• Sharing, not workflow. The NIR does not carry the order, status or the report back to the requester. The imaging order and report loop is SWF.b (RAD-2, RAD-3, RAD-128) in the trust or imaging network; NIR makes the result available to others.
• SOAP (XCA) is used today; FHIR (MHD) is planned. NIR will also use the Patient Data Manager (PDM) FHIR API as a source of document references.