Placer Order Management [LAB-1]

North West Genomic Medicine Service Alliance
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Referenced Standards
Scope
Actor Roles
Messages

Referenced Standards

A. IHE Pathology and Laboratory Medicine (PaLM) Technical Framework - Volume 2a (PaLM TF-2a) Transactions
B. Test Order Forms
- See NW GMSA Genomics Test Order
- Scope

This transaction is used by the Order Placer to place an Order Group (FHIR RequestGroup) (i.e., a set of Orders to be tested together for a patient) or a standalone Order to the Order Filler. The transaction enables both Order Placer and Order Filler to notify all subsequent changes of status and/or content of each Order to the other side.

EIP - Command Message

Actor Roles

Regional Placer Order Management [LAB-1] Component Diagram

Messages

The following messages are used to support creation and updating of the Genomics Test Order aggregation/archetype

Message	Purpose	EIP Type
Laboratory Order	Sending the initial `laboratory-order` request.	Command Message
Laboratory Order Acknowledgement	Is used to update the `order-placer` of changes to `laboratory-order` such as an assigned `AccessionNumber`	Event Message
Laboratory Order Updates	Is used to update master data in the `laboratory-order` such as changes to Patient and Pracitioner details.	Event Message

Laboratory Order

Regional Placer Order Management [LAB-1] Sequence Diagram

Complete Order Test Form

In many Order Placer applications (i.e. the EPR or Order Comms) the order is captured via a form.

Submit Test Order Form (Send HL7 FHIR Message Laboratory Order)

The laboratory order (O21) is sent to the RIA via the $process-message API

FHIR Message Definition: Laboratory Order (O21)

POST [base]/$process-message
Authorization: Basic {accessToken}
Content-Type: application/fhir+json

Example payload Bundle ‘Message’ - Genomics Order

Send HL7 v2 Message and Response HL7 v2 Message

The RIE then sends the converted HL7 v2 Message to the Order Filler (LIMS) which responds back with a ORL_O22? message. Depending on the capabilty of the LIMS system this may include a ORC with an accession number (Filler Order Number) and a PID with updated/new identifiers, these can then be converted to a FHIR ServiceRequest and Patient respectively.

Response HL7 FHIR Message

The response message contains a FHIR MessageHeader with a populated response element, the focus element is not populated.

Accepted

For sucessful messages the MessageHeader will have response.code returned will be ok and will look like:

{
  "resourceType" : "MessageHeader",
  ...
  "response" : {
    "identifier" : "9612365d-52a4-4fab-87e7-8a09d753f095",
    "code" : "ok"
  }
}

Where the identifier refers to the Bundle.identifier in the original message. The Bundle may also include modified FHIR Patient or ServiceRequest resources with updated and new identifiers.

Example payload Bundle ‘Message’ - Genomics Order Acknowledgement

Error/Reject

When the RIE is unable to accept the message due to issues such as FHIR Validation issues, the returned MessageHeader will have response.code returned will be error, e.g.:

{
  "resourceType" : "MessageHeader",
  ...
  "response" : {
    "identifier" : "9612365d-52a4-4fab-87e7-8a09d753f095",
    "code" : "fatal-error",
    "details" : {
      🔗 "reference" : "OperationOutcome/operation-outcome-validate"
    }
  }
}

where the details section contains a reference to an included OperationOutcome listing details of the failure.

Transient Response

When FHIR Validation is active on the RIE, the response will be delayed due to the time taken to validate the message. The immediate response will contain a MessageHeader with a response.code of transient-error, e.g.:

{
  "resourceType" : "MessageHeader",
  ...
  "response" : {
    "identifier" : "9612365d-52a4-4fab-87e7-8a09d753f095",
    "code" : "transient-error"
  }
}

The next section details how to retrieve the response.

Asynchronous Message Response

This follows HL7 FHIR Asynchronous Messaging using the RESTful API

The Order Placer (or TIE) FHIR RESTful query to retrieve their response messages.

GET [base]/Bundle?message.receiver:identifier=[odsCode]&_lastUpdated=[date]
Authorization: Basic {accessToken}
Content-Type: application/fhir+json

Example returned search results Bundle ‘SearchSet’ - Genomics Order

Initially, only queries by ODS Code will be supported to support TIE to TIE exchanges.

Acknowledge Asynchronous HL7 FHIR Messages

Messages that have been accepted by the calling Order Place (or TIE) need to be acknowledged and removed from the MessageQueue. This is achieved by sending back the messages with the sender and destination fields reversed, i.e.

Orignial Message Header

{
  "resourceType" : "MessageHeader",
  ...
  "destination" : [
    {
      "endpoint" : "http://www.acme.org/endpoint/HIVE",
      "receiver" : {
        "identifier" : {
          "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
          "value" : "R0A"
        },
        "display" : "MANCHESTER UNIVERSITY NHS FOUNDATION TRUST"
      }
    }
  ],
  "sender" : {
    "identifier" : {
      "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
      "value" : "699X0"
    },
    "display" : "NORTH WEST GLH"
  },
  ...
  "response" : {
    "identifier" : "9612365d-52a4-4fab-87e7-8a09d753f095",
    "code" : "fatal-error",
    "details" : {
      🔗 "reference" : "OperationOutcome/operation-outcome-validate"
    }
  }
}

Message Header for returned update

{
  "resourceType" : "MessageHeader",
  ...
  "destination" : [
    {
      "endpoint" : "http://www.acme.org/endpoint/HIVE",
      "receiver" : {
        "identifier" : {
          "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
          "value" : "R0A"
        },
        "display" : "MANCHESTER UNIVERSITY NHS FOUNDATION TRUST"
      }
    }
  ],
  "sender" : {
    "identifier" : {
      "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
      "value" : "699X0"
    },
    "display" : "NORTH WEST GLH"
  },
  ...
  "response" : {
    "identifier" : "9612365d-52a4-4fab-87e7-8a09d753f095",
    "code" : "fatal-error",
    "details" : {
      🔗 "reference" : "OperationOutcome/operation-outcome-validate"
    }
  }
}

This update is sent back to the RIE as a FHIR Transaction

POST [base]/
Authorization: Basic {accessToken}
Content-Type: application/fhir+json

{
  "resourceType" : "Bundle",
  "id" : "TransactionGenomicsOrderReplyAck",
  "type" : "transaction",
  "timestamp" : "2024-10-13T10:33:00+00:00",
  "entry" : [
    {
      "fullUrl" : "Bundle/GenomicsOrderMessageReplyAcknowledge",
      "resource" : {
        "resourceType" : "Bundle",
        "id" : "GenomicsOrderMessageReplyAcknowledge",
        "identifier" : {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:9612365d-52a4-4fab-87e7-8a09d753f095"
        },
        "type" : "message",
        "timestamp" : "2024-10-13T10:33:00+00:00",
        "entry" : [
          {
            "fullUrl" : "urn:uuid:9a7e9fd9-d774-42ef-bd23-4397a1ba1b63",
            "resource" : {
              "resourceType" : "MessageHeader",
              "id" : "MessageHeaderGenomicOrderReplyFatalAcknowledge",
              "meta" : {
                "lastUpdated" : "2025-01-29T10:40:26+00:00"
              },
              "eventCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0003",
                "code" : "O21"
              },
              "destination" : [
                {
                  "endpoint" : "http://www.acme.org/endpoint/RIE",
                  "receiver" : {
                    "identifier" : {
                      "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
                      "value" : "699X0"
                    },
                    "display" : "NORTH WEST GLH"
                  }
                }
              ],
              "sender" : {
                "identifier" : {
                  "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
                  "value" : "R0A"
                },
                "display" : "MANCHESTER UNIVERSITY NHS FOUNDATION TRUST"
              },
              "source" : {
                "software" : "NW GLH",
                "endpoint" : "http://www.acme.org/endpoint/HIVE"
              },
              "response" : {
                "identifier" : "9612365d-52a4-4fab-87e7-8a09d753f095",
                "code" : "fatal-error",
                "details" : {
                  🔗 "reference" : "OperationOutcome/operation-outcome-validate"
                }
              }
            }
          }
        ]
      },
      "request" : {
        "method" : "POST",
        "url" : "Bundle"
      }
    }
  ]
}

Validate Message

POST [base]/$validate
Content-Type: application/fhir+json

The incoming order is checked for validity, this may include FHIR Validation against this Implementation Guide. If the message is accepted it is then transformed to a HL7 v2 Message, else a Response HL7 FHIR Message is returned listing the issues in a FHIR OperationOutcome resource.

Transform FHIR to HL7 v2 Message

NOT FOR OPERATIONAL USE

POST [base]:9981/$transformToFHIR
Content-Type: application/hl7-v2+er7

Transform HL7 v2 FHIR Message

NOT FOR OPERATIONAL USE

POST [base]:9981/$transformToV2
Content-Type: application/fhir+json

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