NHS North West Genomics
2.2.0 - ci-build
NHS North West Genomics
2.2.0 - ci-build
NHS North West Genomics - Local Development build (v2.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://fhir.nwgenomics.nhs.uk/Questionnaire/HLATestsTransplantAskAtOrderEntry | Version: 2.2.0 | ||||
| Draft as of 2026-09-20 | Computable Name: | ||||
Ask At Order Entry Questions used alongside the common core order
form for the "HLA Tests - Transplant" order
screen within Histocompatibility and Immunogenetics orders (SNOMED CT
909871000000100) - see
Order Entry Questions and
Histocompatibility and Immunogenetics.
For the sibling Chimerism testing order screen, see
Chimerism Test Additional Ask At Order Entry Questions.
Extracted from the NTE segments (each carrying HL7 v2 Table 0105-style comment type
OSQ) of a live Histotrac ORM^O01 order - see the worked
example for the
full message. Each NTE-3 value uses a local Label:->Value convention (e.g.
HLA Type:->Patient), split below into a question/answer pair.
Research summary (no NHS England-published order-comms/interoperability standard was
found for these fields): NHS England's published pathology standards
(Pathology Test and Results Standard,
SNOMED CT for pathology reporting)
do not cover Histocompatibility and Immunogenetics (H&I) order entry specifically. The
relevant national body is NHS Blood and Transplant (NHSBT), not NHS England: its
INF136 "User Guide for Histocompatibility and Immunogenetics Diagnostics
Services"
defines six national H&I request forms (Table 2) including FRM1008 "H&I Organ
Transplant (Patients and Donors)" and FRM1010 "H&I Haematopoietic Stem Cell
Transplantation (Recipients & Donors)", plus a sample-requirements table listing
"HLA type of patient, donors or family members" for Solid Organ Transplantation -
confirming HLA Type is a fixed national list, not free text, even though NHSBT does not
publish a FHIR/LOINC/SNOMED binding for it. NHSBT's Solid Organ Transplantation section
(4.5.1) also describes 24-hour on-call cover for "renal and, where appropriate,
cardiothoracic transplantation", with liver/other transplant types noted separately
as not having HLA match as a primary factor - consistent with Patient Type being a
small, fixed list. The professional bodies BSHI (British Society for
Histocompatibility and Immunogenetics) and BTS (British Transplantation Society)
jointly publish clinical guidelines (e.g. the
2015 BTS/BSHI antibody characterisation guideline)
but not data/interoperability standards. This IG's own dependency,
HL7's Genomics Reporting IG - Histocompatibility and Immunogenetic
Reporting, profiles
structured HLA genotype/haplotype results (LOINC 84413-4 Genotype display name,
48018-6 Gene studied, 13298-5 HLA-A [Type], the GL String and HGNC systems) but does
not address order-entry "ask at order" questions like these. See each item below for
LOINC panels and UK code lists relevant to that specific question.
Histocompatibility and Immunogenetics
| Question | LinkId | Cardinality | HL7 v2 OML_O21 Message | OBX-2 Value Type | Answer Options | FHIR Field |
|---|---|---|---|---|---|---|
| Patient Test(s) | HistoIG/patient_test |
0..* | OBR-46 | CWE | HLA Typing + Antibody Screening, HLA Antibody Screening, HLA Type Recipient, DSA, HLA Auto XM | ServiceRequest.orderDetail |
| HLA Type | HistoIG/hla_type |
1..1 | OBX | CE | Patient, Donor | Observation.valueCodeableConcept |
| Patient Type | HistoIG/patient_type |
0..1 | OBX | CE | Stem cell, Renal, Thoracic | Observation.valueCodeableConcept |
| Organ | HistoIG/organ |
0..1 | SPM-8 | CWE | Kidney, Pancreas, Islets, Simultaneous Pancreas/Kidney, Simultaneous Islet/Kidney | Specimen.collection.bodySite |
| Specimen Source | HistoIG/specimen_source |
0..1 | SPM-4 | CWE | Blood, Buccal, Other | Specimen.type |
HLA Type and Patient Type are carried as Observations referenced
from ServiceRequest.supportingInfo; Patient Test(s) maps directly to
ServiceRequest.orderDetail; Organ maps to Specimen.collection.bodySite,
the body site the specimen was collected from - see Ask At Order Entry
Questions
for the worked example this Questionnaire was extracted from, and each item's own
design/reference notes below for why every answer option is coded locally against the
NWGMSA CodeSystem rather than a national code system.
Profile: Questionnaire
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  |
**Ask At Order Entry Questions** used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) for the "HLA Tests - Transplant" order screen within Histocompatibility and Immunogenetics orders (SNOMED CT `909871000000100`) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions) and [Histocompatibility and Immunogenetics](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions). For the sibling Chimerism testing order screen, see [Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html). Extracted from the `NTE` segments (each carrying HL7 v2 Table 0105-style comment type `OSQ`) of a live Histotrac `ORM^O01` order - see the worked [example](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions) for the full message. Each `NTE-3` value uses a local `Label:->Value` convention (e.g. `HLA Type:->Patient`), split below into a question/answer pair. **Research summary (no NHS England-published order-comms/interoperability standard was found for these fields)**: NHS England's published pathology standards ([Pathology Test and Results Standard](https://standards.nhs.uk/published-standards/pathology-test-and-results-standard), [SNOMED CT for pathology reporting](https://digital.nhs.uk/services/pathology-standards-and-implementation/snomed-ct-for-pathology-reporting)) do not cover Histocompatibility and Immunogenetics (H&I) order entry specifically. The relevant national body is **NHS Blood and Transplant (NHSBT)**, not NHS England: its [INF136 "User Guide for Histocompatibility and Immunogenetics Diagnostics Services"](https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/29939/inf136.pdf) defines six national H&I request forms (Table 2) including `FRM1008` "H&I Organ Transplant (Patients and Donors)" and `FRM1010` "H&I Haematopoietic Stem Cell Transplantation (Recipients & Donors)", plus a sample-requirements table listing "HLA type of **patient, donors or family members**" for Solid Organ Transplantation - confirming HLA Type is a fixed national list, not free text, even though NHSBT does not publish a FHIR/LOINC/SNOMED binding for it. NHSBT's Solid Organ Transplantation section (4.5.1) also describes 24-hour on-call cover for "**renal** and, where appropriate, **cardiothoracic** transplantation", with liver/other transplant types noted separately as not having HLA match as a primary factor - consistent with Patient Type being a small, fixed list. The professional bodies **BSHI** (British Society for Histocompatibility and Immunogenetics) and **BTS** (British Transplantation Society) jointly publish clinical guidelines (e.g. the [2015 BTS/BSHI antibody characterisation guideline](https://bts.org.uk/wp-content/uploads/2016/09/06_BTS_BSHI_Antibodies-1.pdf)) but not data/interoperability standards. This IG's own dependency, [HL7's Genomics Reporting IG - Histocompatibility and Immunogenetic Reporting](http://hl7.org/fhir/uv/genomics-reporting/histocompatibility.html), profiles structured HLA genotype/haplotype *results* (LOINC `84413-4` Genotype display name, `48018-6` Gene studied, `13298-5` HLA-A [Type], the GL String and HGNC systems) but does not address order-entry "ask at order" questions like these. See each item below for LOINC panels and UK code lists relevant to that specific question. | Questionnaire | https://fhir.nwgenomics.nhs.uk/Questionnaire/HLATestsTransplantAskAtOrderEntry#2.2.0 | |
  AskAtOrderEntry |
Ask At Order Entry Questions | 0..1 | group | Value Set: |
   HistoIG/patient_test |
Patient Test(s) | 0..* | choice | Definition: ServiceRequest.orderDetail Value Set: Options: 5 options |
  HistoIG/patient_test-designNote |
Histotrac NTE-3 (CommentType=OSQ): restates the OBR-4 test name. Mapped to `ServiceRequest.orderDetail` rather than `ServiceRequest.code` - the base [Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own Test Code item already targets `ServiceRequest.code` (single-cardinality), so reusing it here would conflict with no `enableWhen` to say which item wins. `ServiceRequest.orderDetail` is repeating and intended for exactly this kind of further order qualifier, and matches this item's own `repeats = true` (the Hive UI presents them as checkboxes - more than one may be selected per order). Confirmed as this fixed 5-value checklist from the Hive/Histotrac order-entry UI, shown identically regardless of Patient Type (Stem cell or Renal) - coded locally against the `NWGMSA` CodeSystem. | 0..1 | display | Value Set: |
| HistoIG/patient_test-reference |
No MFT/NHS England code set was found for these five specific test names, but LOINC has panels the Histotrac test catalogue could map onto if a coded alternative to the local `NWGMSA` codes is wanted: 102092-4 (HLA-ABDR typing panel), 96615-0/96629-1 (HLA-A/B/C class I typing, high/low resolution), 94492-6 (HLA-DQA1/DQB1 typing), 72905-3 (Neutrophil Ab and HLA Ab screen panel), 94428-0 (HLA class I and II IgG panel), and 80737-0 (Calculated panel reactive antibody). Not the NHS England Genomic Test Directory (England-GenomicTestDirectory) - H&I is not part of that catalogue. | 0..1 | display | Value Set: |
| HistoIG/hla_type |
HLA Type | 1..1 | choice | Definition: Observation.valueCodeableConcept Value Set: Options: 2 options |
| HistoIG/hla_type-designNote |
Whose HLA is being typed - carried as an Observation referenced from ServiceRequest.supportingInfo, the same Ask at Order Entry pattern used by dWGS's Family Structure/Participant Type. Confirmed as a 2-value list (Patient, Donor) from the Hive/Histotrac order-entry UI screenshots - coded locally against the `NWGMSA` CodeSystem as no NHSBT/NHS England-published FHIR/LOINC/SNOMED binding exists. | 0..1 | display | Value Set: |
| HistoIG/hla_type-reference |
NHSBT's INF136 (Table 2) names a national request form "H&I Organ Transplant (Patients and Donors)" (FRM1008), and its sample-requirements table lists "HLA type of patient, donors or family members" for Solid Organ Transplantation - wider than the Patient/Donor pair the Hive UI actually offers. A separate national form, "H&I Haematopoietic Stem Cell Transplantation (Recipients & Donors)" (FRM1010), uses Recipient/Donor instead of Patient/Donor for that transplant type. No NHSBT-published FHIR/LOINC/SNOMED binding exists for either, and Hive does not appear to expose a Family Member/Recipient option here. | 0..1 | display | Value Set: |
| HistoIG/patient_type |
Patient Type | 0..1 | choice | Definition: Observation.valueCodeableConcept Value Set: Options: 3 options |
| HistoIG/patient_type-designNote |
Transplant context - carried as an Observation referenced from ServiceRequest.supportingInfo. Confirmed as a 3-value list (Stem cell, Renal, Thoracic) from the Hive/Histotrac order-entry UI - coded locally against the `NWGMSA` CodeSystem. When Patient Type is "Renal" the Hive UI also shows an Organ picker (see `HistoIG/organ` below); no Organ field is shown for Stem cell/Thoracic. | 0..1 | display | Value Set: |
| HistoIG/patient_type-reference |
NHSBT's INF136 (4.5.1) describes 24-hour on-call cover for "renal and, where appropriate, cardiothoracic transplantation" as the two Solid Organ Transplantation categories with routine H&I on-call support, and the Hive UI's "Thoracic" option lines up with that "cardiothoracic" wording (not "Cardiac"). Stem cell is a third category the Hive UI groups here rather than treating as a separate transplant type. No NHSBT/NHS England LOINC/SNOMED binding was found for this field. | 0..1 | display | Value Set: |
| HistoIG/organ |
Organ | 0..1 | choice | Definition: Specimen.collection.bodySite Value Set: Options: 5 options |
| HistoIG/organ-designNote |
The organ relevant to the transplant - the body site the specimen was collected from. Confirmed as this 5-value list (plus a free-text "Other" box, not modelled here) from the Hive/Histotrac order-entry UI, only shown there when Patient Type is "Renal" - coded locally against the `NWGMSA` CodeSystem, since two of the five values (the two "Simultaneous..." combination transplants) are not themselves single SNOMED CT body-site concepts. | 0..1 | display | Value Set: |
| HistoIG/organ-reference |
For the three single-organ values (Kidney, Pancreas, Islets), SNOMED CT body-site codes from the FHIR body-site value set (https://hl7.org/fhir/R4/valueset-body-site.html) or NHS Digital's UK-specific "Solid organ transplant codes" (ORGTRANSP_COD) reference set (part of the NHS Digital Primary Care Domain Refsets, ~364 codes, https://www.opencodelists.org/codelist/nhsd-primary-care-domain-refsets/orgtransp_cod/) remain candidate future bindings if a coded alternative to the local `NWGMSA` codes is wanted. Neither source has a single code for a combination transplant such as "Simultaneous Pancreas/Kidney", which is why the local coding keeps all five Hive values together as one list rather than splitting by source. | 0..1 | display | Value Set: |
| HistoIG/specimen_source |
Specimen Source | 0..1 | choice | Definition: Specimen.type.coding.code Value Set: Options: 3 options |
| HistoIG/specimen_source-designNote |
Confirmed as this 3-value list (Blood, Buccal, plus a free-text "Other" box, not modelled here) from the Hive/Histotrac order-entry UI's HLA panel - narrower than the EU/UK/NW-compatible [Specimen Type](ValueSet-specimen-type.html) value set previously bound here (`answerValueSet = Canonical(SpecimenType)`), so this item now uses local `NWGMSA` codes to match what Hive actually offers for this exchange. The separate [Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html) order screen in Hive instead offers "Blood (PB)"/"Bone Marrow (BM)". Deliberately given its own `HistoIG/specimen_source` linkId rather than reusing the base [Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own `LN/66746-9` Specimen Type item (same `code`/LOINC `66746-9`, so the semantic link is kept via `code`) - the two questions are asked at different points for different purposes in Hive, and the IG Publisher's Questionnaire derivation validator does not support a `derivedFrom`/`extends` item reusing a base item's linkId while also declaring more than one `answerOption`. | 0..1 | display | Value Set: |
| HistoIG/specimen_source-reference |
NHSBT's INF136 Table 5 (sample requirements) shows nearly every H&I test uses peripheral blood (EDTA and/or clotted, varying by test), with spleen/lymph node as the exception for deceased-donor crossmatching - consistent with Hive's Blood option. If a coded alternative to the local `NWGMSA` codes is wanted, the [Specimen Type](ValueSet-specimen-type.html) value set remains a candidate binding (e.g. whole blood, plasma/serum specimen for Blood; a buccal swab specimen code for Buccal). No dedicated NHS-published specimen-type binding specific to H&I was found. | 0..1 | display | Value Set: |
| Documentation for this format | ||||
Options Sets
Answer options for HistoIG/patient_test
Answer options for HistoIG/hla_type
Answer options for HistoIG/patient_type
Answer options for HistoIG/organ
Answer options for HistoIG/specimen_source
Profile: Questionnaire
Ask At Order Entry Questions
Patient Test(s)
Histotrac NTE-3 (CommentType=OSQ): restates the OBR-4 test name. Mapped to `ServiceRequest.orderDetail` rather than `ServiceRequest.code` - the base [Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own Test Code item already targets `ServiceRequest.code` (single-cardinality), so reusing it here would conflict with no `enableWhen` to say which item wins. `ServiceRequest.orderDetail` is repeating and intended for exactly this kind of further order qualifier, and matches this item's own `repeats = true` (the Hive UI presents them as checkboxes - more than one may be selected per order). Confirmed as this fixed 5-value checklist from the Hive/Histotrac order-entry UI, shown identically regardless of Patient Type (Stem cell or Renal) - coded locally against the `NWGMSA` CodeSystem.
No MFT/NHS England code set was found for these five specific test names, but LOINC has panels the Histotrac test catalogue could map onto if a coded alternative to the local `NWGMSA` codes is wanted: 102092-4 (HLA-ABDR typing panel), 96615-0/96629-1 (HLA-A/B/C class I typing, high/low resolution), 94492-6 (HLA-DQA1/DQB1 typing), 72905-3 (Neutrophil Ab and HLA Ab screen panel), 94428-0 (HLA class I and II IgG panel), and 80737-0 (Calculated panel reactive antibody). Not the NHS England Genomic Test Directory (England-GenomicTestDirectory) - H&I is not part of that catalogue.
HLA Type*
Whose HLA is being typed - carried as an Observation referenced from ServiceRequest.supportingInfo, the same Ask at Order Entry pattern used by dWGS's Family Structure/Participant Type. Confirmed as a 2-value list (Patient, Donor) from the Hive/Histotrac order-entry UI screenshots - coded locally against the `NWGMSA` CodeSystem as no NHSBT/NHS England-published FHIR/LOINC/SNOMED binding exists.
NHSBT's INF136 (Table 2) names a national request form "H&I Organ Transplant (Patients and Donors)" (FRM1008), and its sample-requirements table lists "HLA type of patient, donors or family members" for Solid Organ Transplantation - wider than the Patient/Donor pair the Hive UI actually offers. A separate national form, "H&I Haematopoietic Stem Cell Transplantation (Recipients & Donors)" (FRM1010), uses Recipient/Donor instead of Patient/Donor for that transplant type. No NHSBT-published FHIR/LOINC/SNOMED binding exists for either, and Hive does not appear to expose a Family Member/Recipient option here.
Patient Type
Transplant context - carried as an Observation referenced from ServiceRequest.supportingInfo. Confirmed as a 3-value list (Stem cell, Renal, Thoracic) from the Hive/Histotrac order-entry UI - coded locally against the `NWGMSA` CodeSystem. When Patient Type is "Renal" the Hive UI also shows an Organ picker (see `HistoIG/organ` below); no Organ field is shown for Stem cell/Thoracic.
NHSBT's INF136 (4.5.1) describes 24-hour on-call cover for "renal and, where appropriate, cardiothoracic transplantation" as the two Solid Organ Transplantation categories with routine H&I on-call support, and the Hive UI's "Thoracic" option lines up with that "cardiothoracic" wording (not "Cardiac"). Stem cell is a third category the Hive UI groups here rather than treating as a separate transplant type. No NHSBT/NHS England LOINC/SNOMED binding was found for this field.
Organ
The organ relevant to the transplant - the body site the specimen was collected from. Confirmed as this 5-value list (plus a free-text "Other" box, not modelled here) from the Hive/Histotrac order-entry UI, only shown there when Patient Type is "Renal" - coded locally against the `NWGMSA` CodeSystem, since two of the five values (the two "Simultaneous..." combination transplants) are not themselves single SNOMED CT body-site concepts.
For the three single-organ values (Kidney, Pancreas, Islets), SNOMED CT body-site codes from the FHIR body-site value set (https://hl7.org/fhir/R4/valueset-body-site.html) or NHS Digital's UK-specific "Solid organ transplant codes" (ORGTRANSP_COD) reference set (part of the NHS Digital Primary Care Domain Refsets, ~364 codes, https://www.opencodelists.org/codelist/nhsd-primary-care-domain-refsets/orgtransp_cod/) remain candidate future bindings if a coded alternative to the local `NWGMSA` codes is wanted. Neither source has a single code for a combination transplant such as "Simultaneous Pancreas/Kidney", which is why the local coding keeps all five Hive values together as one list rather than splitting by source.
Specimen Source
Confirmed as this 3-value list (Blood, Buccal, plus a free-text "Other" box, not modelled here) from the Hive/Histotrac order-entry UI's HLA panel - narrower than the EU/UK/NW-compatible [Specimen Type](ValueSet-specimen-type.html) value set previously bound here (`answerValueSet = Canonical(SpecimenType)`), so this item now uses local `NWGMSA` codes to match what Hive actually offers for this exchange. The separate [Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html) order screen in Hive instead offers "Blood (PB)"/"Bone Marrow (BM)". Deliberately given its own `HistoIG/specimen_source` linkId rather than reusing the base [Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own `LN/66746-9` Specimen Type item (same `code`/LOINC `66746-9`, so the semantic link is kept via `code`) - the two questions are asked at different points for different purposes in Hive, and the IG Publisher's Questionnaire derivation validator does not support a `derivedFrom`/`extends` item reusing a base item's linkId while also declaring more than one `answerOption`.
NHSBT's INF136 Table 5 (sample requirements) shows nearly every H&I test uses peripheral blood (EDTA and/or clotted, varying by test), with spleen/lymph node as the exception for deceased-donor crossmatching - consistent with Hive's Blood option. If a coded alternative to the local `NWGMSA` codes is wanted, the [Specimen Type](ValueSet-specimen-type.html) value set remains a candidate binding (e.g. whole blood, plasma/serum specimen for Blood; a buccal swab specimen code for Buccal). No dedicated NHS-published specimen-type binding specific to H&I was found.
Profile: Questionnaire
| LinkID | Description & Constraints |
|---|---|
| AskAtOrderEntry |
Value Set: |
| HistoIG/patient_test |
Definition: ServiceRequest.orderDetail Value Set: Options: 5 options |
| HistoIG/patient_test-designNote |
Value Set: |
| HistoIG/patient_test-reference |
Value Set: |
| HistoIG/hla_type |
Definition: Observation.valueCodeableConcept Value Set: Options: 2 options |
| HistoIG/hla_type-designNote |
Value Set: |
| HistoIG/hla_type-reference |
Value Set: |
| HistoIG/patient_type |
Definition: Observation.valueCodeableConcept Value Set: Options: 3 options |
| HistoIG/patient_type-designNote |
Value Set: |
| HistoIG/patient_type-reference |
Value Set: |
| HistoIG/organ |
Definition: Specimen.collection.bodySite Value Set: Options: 5 options |
| HistoIG/organ-designNote |
Value Set: |
| HistoIG/organ-reference |
Value Set: |
| HistoIG/specimen_source |
Definition: Specimen.type.coding.code Value Set: Options: 3 options |
| HistoIG/specimen_source-designNote |
Value Set: |
| HistoIG/specimen_source-reference |
Value Set: |
| Documentation for this format | |
Try this questionnaire out: