Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for a specific clinical test result, such as an electrocardiogram (ECG)
• Query for a specific imaging test result
• Query for a specific Radiology note (e.g., 84178-3 Interventional Radiology Note)
• Query for a category of reports (e.g., all Cardiology reports)

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Diagnostic Report Must Have:

1. a status
2. a category
3. a code describing the type of report
4. a patient
5. the diagnostically relevant time (known as the "effective time" and typically the time of the procedure)*

*This element has the following constraint: SHALL be present if status is 'partial', 'preliminary', 'final', 'amended', 'corrected', or 'appended'.

Each Diagnostic Report Must Support:

1. encounter associated with DiagnosticReport
2. instant the report was released
3. an author (actor) producing the report
4. a reference to one or more test results
5. a reference to one or more images
6. a reference to the full report (presentedForm)

Profile Specific Implementation Guidance:

• See Clinical Notes
• The DiagnosticReport.category binding Must Support, at a minimum, the IE Core DiagnosticReport Category Codes of Cardiology, Radiology, and Pathology. Other categories may be supported.
  • It is up to the data source to categorize the documents they send. Therefore, clients need to understand that data categorization is somewhat subjective, and the categorization applied by the source may not align with the client's expectations. Any linkages between specific LOINC codes and the LP-type codes may be used as guidance. If LOINC develops a hierarchy or categorization to align these concepts, IE Core will be updated.
• A server will return how a customer has categorized their reports at a particular site. Categorization of reports is not consistent across sites. (e.g., a system may categorize an orthopedic note as cardiology.)

• For Diagnostic Imaging Reports systems SHOULD support using the subset of LOINC codes defined in CONF-DIR-19 in *HL7 Implementation Guide for CDA Release 2: Imaging Integration, Levels 1, 2, and 3, Basic Imaging Reports in CDA and DICOM Diagnostic Imaging Reports (DIR) - Universal Realm, Release 1.0.

• Diagnostic imaging results in visual images requiring interpretation and clinical test results/reports may also reference images as part of the report. There is no single approach for accessing imaging studies alongside clinical data using a single authorization flow to give patients and providers access to the images.

  • The media.link element is marked as Must Support, and the Media resource to which it links can support various patient-friendly content, such as jpg images of x-rays (see the DiagnosticReport Chest X-ray Report Example).
  • DICOM studies, series, and SOP instances are encoded as UUID identifiers in the ImagingStudy resource, which is referenced by the imagingStudy element. Systems with the tools and specific viewers can use this optional element to view these images.
  • Alternatively, systems can use business identifiers such as accession numbers in the identifier element to access the source images from external sources.

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the IE Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only IE Core Profiles (Profile Only Support) are not required to support these interactions. See the IE Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• See the Scopes Format section for a description of the SMART scopes syntax.
• See the Search Syntax section for a description of the IE Core search syntax.
• See the General Requirements section for additional rules and expectations when a server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

IE Core Scopes

Servers providing access to clniical note data SHALL support these IE Core SMART Scopes:

• resource level scopes: <patient|user|system>/DiagnosticReport.rs

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching for all diagnosticreports for a patient using the patient search parameter:

   GET [base]/DiagnosticReport?patient={Type/}[id]

   Example:

   1. GET [base]/DiagnosticReport?patient=1137192

   Implementation Notes: Fetches a bundle of all DiagnosticReport resources for the specified patient (how to search by reference)

2. SHALL support searching using the combination of the patient and category search parameters:

   GET [base]/DiagnosticReport?patient={Type/}[id]&category={system|}[code]

   Example:

   1. GET [base]/DiagnosticReport?patient=f201&category=http://loinc.org|LP29684-5

   Implementation Notes: Fetches a bundle of all DiagnosticReport resources for the specified patient and a category code specified in IE Core DiagnosticReport Category Codes (how to search by reference and how to search by token)

3. SHALL support searching using the combination of the patient and code search parameters:
   • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

   GET [base]/DiagnosticReport?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/DiagnosticReport?patient=1032702&code=http://loinc.org|24323-8

   Implementation Notes: Fetches a bundle of all DiagnosticReport resources for the specified patient and report code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token)

4. SHALL support searching using the combination of the patient and category and date search parameters:
   • including support for these date comparators: gt,lt,ge,le
   • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

   GET [base]/DiagnosticReport?patient={Type/}[id]&category={system|}[code]&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/DiagnosticReport?patient=f201&category=http://loinc.org|LP29684-5&date=ge2010-01-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all DiagnosticReport resources for the specified patient and date and a category code specified in IE Core DiagnosticReport Category Codes (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and status search parameters:
   • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

   GET [base]/DiagnosticReport?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/DiagnosticReport?patient=1137192&status=completed

   Implementation Notes: Fetches a bundle of all DiagnosticReport resources for the specified patient and status (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the patient and code and date search parameters:
   • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
   • including support for these date comparators: gt,lt,ge,le
   • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

   GET [base]/DiagnosticReport?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/DiagnosticReport?patient=f201&code=http://loinc.org|24323-8&date=ge2019-01-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all DiagnosticReport resources for the specified patient and date and report code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token and how to search by date)

3. SHOULD support searching using the combination of the patient and category and _lastUpdated search parameters:
   • including support for these _lastUpdated comparators: gt,lt,ge,le
   • including optional support for AND search on _lastUpdated (e.g._lastUpdated=[date]&_lastUpdated=[date]]&...)

   GET [base]/DiagnosticReport?patient={Type/}[id]&category={system|}[code]&_lastUpdated={gt|lt|ge|le}[date]{&_lastUpdated={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/DiagnosticReport?patient=f201&category=http://loinc.org|LP29684-5&_lastUpdated=ge2010-01-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all DiagnosticReport resources for the specified patient and a category code specified in IE Core DiagnosticReport Category Codes and _lastUpdated. See the IE Core General Guidance page for Searching Using lastUpdated. (how to search by reference and how to search by token and how to search by date)