DiagnosticReport

A diagnostic report is the set of information that is typically provided by a diagnostic service when investigations are complete.

Overview

The information includes a mix of atomic results, text reports, images, and codes. The mix varies depending on the nature of the diagnostic procedure, and sometimes on the nature of the outcomes for a particular investigation.

This profile is used to define the content that will be returned by the API Server in response to requests to access DiagnosticReport resources. All elements described in the Definition and Detailed Definitions below are supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

Definition

The official URL for this profile is:

https://fhir.athena.io/StructureDefinition/ah-diagnosticreport

The base definition for this profile is:

DiagnosticReport

NameFlagsCard.TypeDescription & Constraintsdoco
.. DiagnosticReport0..*DiagnosticReportA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
... idΣ0..1idLogical id of this artifact
... metaΣ0..1MetaMetadata about the resource
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionIdΣ0..1idVersion specific identifier
.... lastUpdatedΣ0..1instant (YYYY-MM-DDThh:mm:ss.sss+zz:zz)When the resource version last changed
.... sourceΣ0..1uriIdentifies where the resource comes from
.... profileΣ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... securityΣ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tagΣ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules?!Σ0..1uriA set of rules under which this content was created
... text0..1NarrativeText summary of the resource, for human interpretation
... contained0..*ResourceContained, inline Resources
... Slices for extension1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ahChartSharingGroup0..1Reference(Organization)athenahealth Chart Sharing Group
URL: https://fhir.athena.io/StructureDefinition/ah-chart-sharing-group
... ahPractice1..1Reference(Organization)athenahealth Practice
URL: https://fhir.athena.io/StructureDefinition/ah-practice
... modifierExtension?!0..*ExtensionExtensions that cannot be ignored
... identifierΣ0..*IdentifierBusiness identifier for report
... status?!Σ1..1coderegistered | partial | preliminary | final +
Binding: DiagnosticReportStatus (required): The status of the diagnostic report.

... categoryΣ0..*CodeableConceptService category
Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.


... codeΣ1..1CodeableConceptName/Code for this diagnostic report
Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports.

... subjectΣ0..1Reference(Patient)The subject of the report - usually, but not always, the patient
... encounterΣ0..1Reference(Encounter)Health care event when test ordered
... effective[x]Σ0..1dateTime (YYYY-MM-DDThh:mm:ss+zz:zz)Clinically relevant time/time-period for report
... issuedΣ0..1instant (YYYY-MM-DDThh:mm:ss.sss+zz:zz)DateTime this version was made
... performerΣ0..*Reference(Practitioner | Organization)Responsible Diagnostic Service
... result0..*Reference(Observation)Observations
... presentedForm0..*AttachmentEntire report as issued

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
DiagnosticReport.meta.securityextensibleAll Security Labels
DiagnosticReport.meta.tagexampleCommonTags
DiagnosticReport.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
DiagnosticReport.statusrequiredDiagnosticReportStatus
DiagnosticReport.categoryexampleDiagnosticServiceSectionCodes
DiagnosticReport.codepreferredLOINCDiagnosticReportCodes (a valid code from LOINC)

Detailed Definitions


DiagnosticReport

The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.

Cardinality 0..*
Type Root
Comments This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

DiagnosticReport.id

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Cardinality 0..1
Type id
Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

DiagnosticReport.meta

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Cardinality 0..1
Type Meta

DiagnosticReport.meta.id

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1
Type string

DiagnosticReport.meta.extension

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

DiagnosticReport.meta.versionId

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

Cardinality 0..1
Type id
Comments The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

DiagnosticReport.meta.lastUpdated

When the resource last changed - e.g. when the version changed.

Cardinality 0..1
Type instant (YYYY-MM-DDThh:mm:ss.sss+zz:zz)
Comments This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

DiagnosticReport.meta.source

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

Cardinality 0..1
Type uri
Comments In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

DiagnosticReport.meta.profile

A list of profiles (references to StructureDefinition.

Cardinality 0..*
Type canonical
Comments It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

DiagnosticReport.meta.security

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Cardinality 0..*
Type Coding Binding: All Security Labels (extensible)
Comments meta.security may contain the following: an item with code 'NOPAT' if the resource is not patient facing, and/or an item with code 'SUBSETTED' if the _query search parameter is defined.

DiagnosticReport.meta.tag

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Cardinality 0..*
Type Coding Binding: CommonTags (example)
Comments The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

DiagnosticReport.implicitRules

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Cardinality 0..1
Type uri
Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

DiagnosticReport.language

The base language in which the resource is written.

Cardinality 0..1
Type code Binding: CommonLanguages (preferred)
Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

DiagnosticReport.text

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Cardinality 0..1
Type Narrative
Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

DiagnosticReport.contained

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Cardinality 0..*
Type Resource
Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

DiagnosticReport.extension

An Extension

Cardinality 1..*
Type Extension

DiagnosticReport.extension:ahChartSharingGroup

An Extension used to reference a specific athenahealth chart sharing group Organization.

Cardinality 0..1
Type Extension(AthenaChartSharingGroup)

DiagnosticReport.extension:ahPractice

An Extension used to reference a specific athenahealth practice Organization.

Cardinality 1..1
Type Extension(AthenaPractice)

DiagnosticReport.modifierExtension

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Requirements Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

DiagnosticReport.identifier

Identifiers assigned to this report by the performer or other systems.

Cardinality 0..*
Type Identifier
Comments Usually assigned by the Information System of the diagnostic service provider (filler id).
Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

DiagnosticReport.status

The status of the diagnostic report.

Cardinality 1..1
Type code Binding: DiagnosticReportStatus (required)
Requirements Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

DiagnosticReport.category

A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

Cardinality 0..*
Type CodeableConcept Binding: DiagnosticServiceSectionCodes (example)
Comments Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

DiagnosticReport.code

A code or name that describes this diagnostic report.

Cardinality 1..1
Type CodeableConcept Binding: LOINCDiagnosticReportCodes (preferred)

DiagnosticReport.subject

The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

Cardinality 0..1
Type Reference(Patient)
Requirements SHALL know the subject context.

DiagnosticReport.encounter

The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.

Cardinality 0..1
Type Reference(Encounter)
Comments This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
Requirements Links the request to the Encounter context.

DiagnosticReport.effective[x]

The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

Cardinality 0..1
Type dateTime (YYYY-MM-DDThh:mm:ss+zz:zz)
Comments If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.
Requirements Need to know where in the patient history to file/present this report.

DiagnosticReport.issued

The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

Cardinality 0..1
Type instant (YYYY-MM-DDThh:mm:ss.sss+zz:zz)
Comments May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.
Requirements Clinicians need to be able to check the date that the report was released.

DiagnosticReport.performer

The diagnostic service that is responsible for issuing the report.

Cardinality 0..*
Type Reference(Practitioner | Organization)
Comments This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.
Requirements Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

DiagnosticReport.result

Observations that are part of this diagnostic report.

Cardinality 0..*
Type Reference(Observation)
Comments Observations can contain observations.
Requirements Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

DiagnosticReport.presentedForm

Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

Cardinality 0..*
Type Attachment
Comments "application/pdf" is recommended as the most reliable and interoperable in this context.
Requirements Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

Interactions

READ

Read interactions are executed as specified in the HL7 FHIR RESTful API read specification. To read DiagnosticReport resources, an application will perform an HTTP GET specifying the logical ID of the DiagnosticReport being retrieved.

The [patient|user|system]/DiagnosticReport.read authorization scope is required.

GET
/fhir/r4/DiagnosticReport/{logicalId}
Try in Postman

Parameters

required

conditional required

Name Type Description
logicalId string (REQUIRED) The logical ID of the resource (alias: Resource.id). It is specified in the URL path and not as a query parameter.

Response Codes

Response code Description
200 OK The requested DiagnosticReport resource was found and is contained within the body of the HTTP response.
400 Bad Request The server could not understand the request due to invalid syntax. The body of the HTTP response will contain an OperationOutcome resource that indicates the invalid request could not be processed.
404 Not Found The requested resource does not exist. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
410 Gone The requested resource has been permanently deleted from server with no forwarding address. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

GET SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for DiagnosticReport resources using the HTTP GET method, an application will perform the HTTP GET specifying the query parameters associated with the DiagnosticReport in the URL.

The [patient|user|system]/DiagnosticReport.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/CareTeam.read
  • [patient|user|system]/Encounter.read
  • [patient|user|system]/Observation.read
  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Practitioner.read
  • [patient|user|system]/Provenance.read

GET
/fhir/r4/DiagnosticReport
Try in Postman

Parameters

DiagnosticReport search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
_id token (CONDITIONAL REQUIRED) DiagnosticReport.id resource reference to FHIR DiagnosticReport resource
_query string Custom named query
encounter reference Resource reference to FHIR Encounter resource
patient reference (CONDITIONAL REQUIRED) DiagnosticReport.subject resource reference to FHIR Patient resource
category token DiagnosticReport.category is the parameter for searching on category
code token DiagnosticReport.code is the parameter for searching on code
date date DiagnosticReport.effective is the parameter for searching on date
_count number The number of DiagnosticReport resources to return per page for paged search results.
cursor token Search by cursor token for first resource to return in a paged search result
result reference DiagnostReport.result resource reference to FHIR Obserrvation resource
performer reference DiagnosticReport.performer resource reference to the FHIR Practitioner or Organization resource
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • DiagnosticReport:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • DiagnosticReport:encounter - Included resource(s) Encounter and required scope(s) [patient|user|system]/Encounter.read
  • DiagnosticReport:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
  • DiagnosticReport:result - Included resource(s) Observation and required scope(s) [patient|user|system]/Observation.read
  • DiagnosticReport:performer - Included resource(s) CareTeam, Organization, Practitioner and required scope(s) [patient|user|system]/CareTeam.read, [patient|user|system]/Organization.read, [patient|user|system]/Practitioner.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

POST SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for DiagnosticReport resources using the HTTP POST method, an application will perform the HTTP POST specifying the query parameters associated with the DiagnosticReport in the request body.

The [patient|user|system]/DiagnosticReport.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/CareTeam.read
  • [patient|user|system]/Encounter.read
  • [patient|user|system]/Observation.read
  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Practitioner.read
  • [patient|user|system]/Provenance.read

POST
/fhir/r4/DiagnosticReport/_search
Try in Postman

Request Header

Content-Type: application/x-www-form-urlencoded

Request Body

param1=value1&param2=value2...

Parameters

DiagnosticReport search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
_id token (CONDITIONAL REQUIRED) DiagnosticReport.id resource reference to FHIR DiagnosticReport resource
_query string Custom named query
encounter reference Resource reference to FHIR Encounter resource
patient reference (CONDITIONAL REQUIRED) DiagnosticReport.subject resource reference to FHIR Patient resource
category token DiagnosticReport.category is the parameter for searching on category
code token DiagnosticReport.code is the parameter for searching on code
date date DiagnosticReport.effective is the parameter for searching on date
_count number The number of DiagnosticReport resources to return per page for paged search results.
cursor token Search by cursor token for first resource to return in a paged search result
result reference DiagnostReport.result resource reference to FHIR Obserrvation resource
performer reference DiagnosticReport.performer resource reference to the FHIR Practitioner or Organization resource
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • DiagnosticReport:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • DiagnosticReport:encounter - Included resource(s) Encounter and required scope(s) [patient|user|system]/Encounter.read
  • DiagnosticReport:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
  • DiagnosticReport:result - Included resource(s) Observation and required scope(s) [patient|user|system]/Observation.read
  • DiagnosticReport:performer - Included resource(s) CareTeam, Organization, Practitioner and required scope(s) [patient|user|system]/CareTeam.read, [patient|user|system]/Organization.read, [patient|user|system]/Practitioner.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
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