DRAFT Implementation Guide

This is for collaboration and discussion purposes and is subject to change.

North West Genomic Medicine Service Alliance - Local Development build (v0.0.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Order Results Management [LAB-3]

Referenced Standards

• A. IHE Pathology and Laboratory Medicine (PaLM) Technical Framework - Volume 2a (PaLM TF-2a) Transactions
• B. HL7 Version 2.5.1 Implementation Guide: Lab Results Interface (LRI), Release 1 from May 2017

Scope

It transmits the observation results from the Order Filler to the Order Result Tracker, when a result is acquired, clinically validated, modified or deleted at the Order Filler level.

EIP - Document Message

Actor Roles

Message

The following messages are used to support creation and updating of the Genomics Test Report composition

Laboratory Results

Is based on a HL7 FHIR unsolicited-observation (R01) Message which is backwards compatible with HL7 v2 ORU_R01 Message.

Detailed Mapping can be here Message ORU_R01 to Bundle Map (Experimental)

Asynchronous Message Delivery

During initial phases the ‘laboratory report’ will be delivered following a EIP Polling Consumer pattern. This will follow HL7 FHIR Asynchronous Messaging using the RESTful API

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

GET [base]/Bundle?message.receiver:identifier=[odsCode]&_lastUpdated=[date]

Example returned search results Bundle ‘SearchSet’ - Genomics Order

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

Update 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",
  "id" : "MessageHeaderGenomicReport",
  "meta" : {
    "lastUpdated" : "2025-02-01T13:39:26+00:00"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader MessageHeaderGenomicReport</b></p><a name=\"MessageHeaderGenomicReport\"> </a><a name=\"hcMessageHeaderGenomicReport\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2025-02-01 13:39:26+0000</p></div><p><b>event</b>: <a href=\"http://terminology.hl7.org/6.2.0/CodeSystem-v2-0003.html#v2-0003-R01\">eventType R01</a>: ORU/ACK - Unsolicited transmission of an observation message</p><h3>Destinations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://simplifier.net/resolve?scope=fhir.r4.ukcore.stu3.currentbuild@0.0.19-pre-release&amp;canonical=https://simplifier.net/guide/ukcoreversionhistory/https//tie.alderhey.nhs.uk\">https//tie.alderhey.nhs.uk</a></td><td>ALDER HEY CHILDREN'S NHS FOUNDATION TRUST (Identifier: <code>https://fhir.nhs.uk/Id/ods-organization-code</code>/RBS)</td></tr></table><p><b>sender</b>: NORTH WEST GLH (Identifier: <code>https://fhir.nhs.uk/Id/ods-organization-code</code>/699X0)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Software</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>GMSA RIE</td><td><a href=\"https://simplifier.net/resolve?scope=fhir.r4.ukcore.stu3.currentbuild@0.0.19-pre-release&amp;canonical=https://simplifier.net/guide/ukcoreversionhistory/https//rie.nw-gmsa.nhs.uk/\">https//rie.nw-gmsa.nhs.uk/</a></td></tr></table><p><b>focus</b>: </p><ul><li><a href=\"Bundle-GenomicsReportMessage.html#urn-uuid-233ff41a-5067-46c4-b6aa-5d6f87719f5f\">Bundle: identifier = https://tools.ietf.org/html/rfc4122#9612365d-52a4-4fab-87e7-8a09d753f095; type = message; timestamp = 2024-10-13 10:33:00+0000</a></li><li><a href=\"Bundle-FHIRDocumentGeneticReportBundle.html#urn-uuid-94bf65ba-cd6c-4601-b339-6d547f424646\">Bundle: identifier = urn:oid:2.16.724.4.8.10.200.10#1d7155e8-b5b8-4406-adda-01a474d5ff6c; type = document; timestamp = 2024-10-13 10:33:00+0000</a></li></ul></div>"
  },
  "eventCoding" : {
    "system" : "http://terminology.hl7.org/CodeSystem/v2-0003",
    "code" : "R01"
  },
  "destination" : [
    {
      "endpoint" : "https//tie.alderhey.nhs.uk",
      "receiver" : {
        "identifier" : {
          "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
          "value" : "RBS"
        },
        "display" : "ALDER HEY CHILDREN'S NHS FOUNDATION TRUST"
      }
    }
  ],
  "sender" : {
    "identifier" : {
      "system" : "https://fhir.nhs.uk/Id/ods-organization-code",
      "value" : "699X0"
    },
    "display" : "NORTH WEST GLH"
  },
  "source" : {
    "software" : "GMSA RIE",
    "endpoint" : "https//rie.nw-gmsa.nhs.uk/"
  },
  "focus" : [
    {
      "reference" : "urn:uuid:233ff41a-5067-46c4-b6aa-5d6f87719f5f",
      "type" : "DiagnosticReport"
    },
    {
      "reference" : "urn:uuid:94bf65ba-cd6c-4601-b339-6d547f424646",
      "type" : "DocumentReference"
    }
  ]
}

Message Header for returned update

{
  "resourceType" : "MessageHeader",
  "id" : "MessageHeaderGenomicReportAck",
  "meta" : {
    "lastUpdated" : "2025-02-01T13:39:26+00:00"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader MessageHeaderGenomicReportAck</b></p><a name=\"MessageHeaderGenomicReportAck\"> </a><a name=\"hcMessageHeaderGenomicReportAck\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2025-02-01 13:39:26+0000</p></div><p><b>event</b>: <a href=\"http://terminology.hl7.org/6.2.0/CodeSystem-v2-0003.html#v2-0003-R01\">eventType R01</a>: ORU/ACK - Unsolicited transmission of an observation message</p><h3>Destinations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://simplifier.net/resolve?scope=fhir.r4.ukcore.stu3.currentbuild@0.0.19-pre-release&amp;canonical=https://simplifier.net/guide/ukcoreversionhistory/https//rie.nw-gmsa.nhs.uk\">https//rie.nw-gmsa.nhs.uk</a></td><td>NORTH WEST GLH (Identifier: <code>https://fhir.nhs.uk/Id/ods-organization-code</code>/699X0)</td></tr></table><p><b>sender</b>: ALDER HEY CHILDREN'S NHS FOUNDATION TRUST (Identifier: <code>https://fhir.nhs.uk/Id/ods-organization-code</code>/RBS)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Software</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>Alder Hey TIE</td><td><a href=\"https://simplifier.net/resolve?scope=fhir.r4.ukcore.stu3.currentbuild@0.0.19-pre-release&amp;canonical=https://simplifier.net/guide/ukcoreversionhistory/https//tie.alderhey.nhs.uk/\">https//tie.alderhey.nhs.uk/</a></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>9612365d-52a4-4fab-87e7-8a09d753f095</td><td>OK</td></tr></table><p><b>focus</b>: </p><ul><li><a href=\"Bundle-GenomicsReportMessage.html#urn-uuid-233ff41a-5067-46c4-b6aa-5d6f87719f5f\">Bundle: identifier = https://tools.ietf.org/html/rfc4122#9612365d-52a4-4fab-87e7-8a09d753f095; type = message; timestamp = 2024-10-13 10:33:00+0000</a></li><li><a href=\"Bundle-FHIRDocumentGeneticReportBundle.html#urn-uuid-94bf65ba-cd6c-4601-b339-6d547f424646\">Bundle: identifier = urn:oid:2.16.724.4.8.10.200.10#1d7155e8-b5b8-4406-adda-01a474d5ff6c; type = document; timestamp = 2024-10-13 10:33:00+0000</a></li></ul></div>"
  },
  "eventCoding" : {
    "system" : "http://terminology.hl7.org/CodeSystem/v2-0003",
    "code" : "R01"
  },
  "destination" : [
    {
      "endpoint" : "https//rie.nw-gmsa.nhs.uk",
      "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" : "RBS"
    },
    "display" : "ALDER HEY CHILDREN'S NHS FOUNDATION TRUST"
  },
  "source" : {
    "software" : "Alder Hey TIE",
    "endpoint" : "https//tie.alderhey.nhs.uk/"
  },
  "response" : {
    "identifier" : "9612365d-52a4-4fab-87e7-8a09d753f095",
    "code" : "ok"
  },
  "focus" : [
    {
      "reference" : "urn:uuid:233ff41a-5067-46c4-b6aa-5d6f87719f5f",
      "type" : "DiagnosticReport"
    },
    {
      "reference" : "urn:uuid:94bf65ba-cd6c-4601-b339-6d547f424646",
      "type" : "DocumentReference"
    }
  ]
}

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

POST [base]/