North West Genomic Medicine Service Alliance - Local Development build (v0.0.7) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
This option is the existing exchange of ORM_O01/OML_O21 Orders and ORU_R01 Reports, these messages are in either HL7 v2 Pipe+Hat or FHIR Message JSON formats, the messages follow the same semantic model.
This also follows IHE Laboratory and Testing Workflow (LTW)
Messaging Flow:
Complete Referral Form
The Order Placer completes an order form.
Placer Order Management (LAB-1) Genomic Order O21 – Command Message
A Genomic Order O21 is sent from the Order Placer to the Order Filler.
Purpose: To initiate and communicate the genomic testing order.
Perform Test
The Order Filler processes the order and performs the test.
Order Results Management (LAB-3) Genomic Report R01 – Document Message
A document message (HL7 ORU_R01) is sent from the Order Filler back to the Order Placer.
This may include preliminary and partial reports before the final report.
Purpose: To report the results of the genomic test.
Pros/Cons
Makes use of Messaging Patterns and so in secondary care has considerable middleware via Trust Integration Engines (TIE).
Does not support referral triage processes or other workflow interactions.
UK and England HL7 standards (including UKCore) do not cover this workflow, especially around the use of business identifiers.
The order and report messages are semantically aligned and compatible (HL7 v2 and FHIR) with:
NHS England HL7 Message Specification
NHS England Data Model and Dictionary
Digital Health and Care Wales - HL7 ORU_R01 2.5.1 Implementation Guide
The FHIR Messages defined in this specification are not part of this standard (or another standard), but are following LAB-1 and LAB-3.
Security—all interactions will use OAuth2 Authorisation (this includes HL7 over http)
Notes
The NHS England Genomic Order Management Service - Process genomic test request is effectively a HL7 Message same as the Genomic Order O21 Command Message. This does not support Genomic Report R01 Document Message
Traditional Messaging plus Enterprise Clinical Data Repository Option
Advanced, flexible, and interoperable genomic reporting workflow that combines traditional HL7 messaging with FHIR-based workflows and centralized data repositories, offering a future-ready health data exchange model.
This is an evolution of the previous option by adding in an Enterprise Clinical Data Repository (CDR) which allows Genomic Orders and Reports data to be shared across the region.
Messaging Flow:
Initial Order Message:
The Order Placer completes an order form.
Sends a Genomic Order O21 Command Message to RIE.
RIE forwards this command to both the CDR and Order Filler.
Optional FHIR Workflow (ALT Path):
FHIR Task with an accepted status is created from the Genominc Order O21 Message and is sent to the CDR.
This begins the FHIR-based workflow as an alternative to traditional HL7 messaging.
Test Execution:
The Order Filler performs the genomic test.
Preliminary/Partial Results Reporting:
The Genomic Report R01 Document Message is sent from the Order Filler to CDR, this is used to store new FHIR resource and updating existing ones such as the ServiceRequest to a completed status.
- The FHIR Task is updated to with a in-progress status and is then sent to indicate completion of the task.
Result Reporting:
The Genomic Report R01 Document Message is sent from the Order Filler to CDR, this is used to store new FHIR resource and updating existing ones such as the ServiceRequest to a completed status.
The FHIR Task is updated to with a completed status and is then sent to indicate completion of the task.
Result Retrieval Options:
The Order Placer retrieves results via traditional HL7 v2 ORU_R01 Document Message.
Pro/Cons
Hybrid Support: Works with both HL7 v2 and FHIR.
Scalability: Central CDR enables easier data sharing across systems.
Interoperability: Complies with widely accepted health IT standards.
Flexibility: Supports event-driven or request-driven access to results.
Initial support for FHIR Worlflow which is central to the NHS England Genomic Order Management Service.
FHIR Workflow plus Enterprise Clinical Data Repositories Option
A fully FHIR-based, repository-driven genomic workflow, enabling secure, scalable, and flexible collaboration between order placers and fillers through shared data access and event-driven communication.
Scope: This option is initially aimed at regional and national level workflows. I.e., the Order Placer (or Filler) can be NHS England Genomic Order Managment System or North West GMSA RIE+CDR.
This differs from the current proposal to send in Genomic Test Requests via messaging (Process genomic test request), instead they would be shared from the enterprise CDR, and the request to process genomic test request would be Create a new Task
Messaging Flow:
Initiation:
The Order Placer completes a referral form.
A Genomic Order is stored on the Order Placer’s Clinical Data Repository.
When the order is placed with the North West region, this will be a Genomic Order O21 Message, which the RIE sends to the Enterprise CDR.
A FHIR Task (requested) event message is also generated.
Order Acceptance & Retrieval:
The Order Filler Clinical Data Repository retrieves the order using Placer Order Management (LAB-1) Genomic Order O21 REST API.
A FHIR Task with a status of accepted event message is returned to the Order Placer confirming acceptance.
Test Execution:
The Order Filler performs the genomic test.
Results Submission:
The Order Filler creates the Genomic Report (which may have multiple versions e.g., partial, preliminary, and final)
The Genomic Report is stored on the Order Filler Clinical Data Repository.
When the order is stored within the North West region, this will be via a Genomic Report R01 Message, which the RIE sends to the Enterprise CDR.
The FHIR Task event message with a status of completed is sent back to the Order Placer.
Result Retrieval:
The Order Placer retrieves the genomic report FHIR REST API from the Order Filler’s Clinical Data Repository.
The RIE on reciept of a completed task will then convert the report to a Genomic Report R01 Message and send onto the original Order Placer.
Pro/Cons
Orders and results are shared via FHIR repositories and APIs rather than direct HL7 v2 messages.
Provides an alternative to message-based workflow.
Decouples systems – allowing asynchronous, federated access to shared data.
Scalability & Interoperability: Built for modern health IT ecosystems.
Flexibility: Systems can retrieve data when needed.
FHIR-Centric: Enables real-time tracking and status updates via FHIR Task.
Federated Genomic Data Access and Health Information Exchange (HIE) Option
This approach enables real-time, federated access to patient data spread across multiple NHS organizations, without needing to centralize all data. It supports clinical portals that provide clinicians with a holistic view of patient information while respecting data sovereignty and system independence.
Notable examples of this pattern include:
NHS Scotland South-East Region (XML/SOAP API)
Yorkshire and Humberside Care Record (FHIR STU3 REST API + Care Connect API)
The system or application (e.g., a clinical portal) that initiates the query to retrieve patient data.
Health Information Exchange - Regional Integration Engine (RIE)
Acts as the central orchestrator that receives the query and distributes it across multiple data sources.
Clinical Data Sources
Examples shown:
NW GMSA (North West Genomic Medicine Service Alliance)
NHS England GOMS (Genomics Order Medical Services)
These are systems that store patient genomic records and respond to data queries.
Additional clinical data repositories can be integrated into the HIE. This includes systems from regional NHS Trusts that already support IHE QEDm-compatible FHIR REST APIs in their EPR platforms—such as Meditech, EPIC, and Oracle.
Sequence of Events (from top to bottom):
Initial Query
The Clinical Data Consumer sends a FHIR REST API request using IHE Query Existing Data (QEDm) PCC-44 to the RIE.
Federated Query Access Start
The RIE starts a federated query process.
It forwards the same IHE QEDm PCC-44 query to each connected clinical data source.
Responses from Data Sources
Each clinical data source responds individually with relevant data.
Aggregation
The RIE aggregates the responses from all sources into a unified result set.
Final Response
The aggregated data is sent back to the Clinical Data Consumer as a single, combined response.
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