NHS North West Genomics
2.2.5 - ci-build
NHS North West Genomics
2.2.5 - ci-build
NHS North West Genomics - Local Development build (v2.2.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2026-11-05 |
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"id" : "HLATestsTransplantAskAtOrderEntry",
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🔗 "https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"
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"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire HLATestsTransplantAskAtOrderEntry</b></p><a name=\"HLATestsTransplantAskAtOrderEntry\"> </a><a name=\"hcHLATestsTransplantAskAtOrderEntry\"> </a><div style=\"display: inline-block; background-color: #fbffeb; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-NWQuestionnaire.html\">Questionnaire</a></p></div><b>Structure</b><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" class=\"xhtTableBorder1\"><tr class=\"xhtRowBorder2\"><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description & Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck1.png)\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> </td><td style=\"\" class=\"hierarchy xhtCellBorder1\">**Ask At Order Entry Questions** used alongside the [common core order\nform](StructureDefinition-GenomicTestOrder.html) for the "HLA Tests - Transplant" order\nscreen within Histocompatibility and Immunogenetics orders (SNOMED CT\n`909871000000100`) - see\n[Order Entry Questions](StructureDefinition-GenomicTestOrder.html#order-entry-questions) and\n[Histocompatibility and Immunogenetics](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions).\nFor the sibling Chimerism testing order screen, see\n[Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html).\n\nExtracted from the `NTE` segments (each carrying HL7 v2 Table 0105-style comment type\n`OSQ`) of a live Histotrac `ORM^O01` order - see the worked\n[example](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions) for the\nfull message. Each `NTE-3` value uses a local `Label:->Value` convention (e.g.\n`HLA Type:->Patient`), split below into a question/answer pair.\n\n**Research summary (no NHS England-published order-comms/interoperability standard was\nfound for these fields)**: NHS England's published pathology standards\n([Pathology Test and Results Standard](https://standards.nhs.uk/published-standards/pathology-test-and-results-standard),\n[SNOMED CT for pathology reporting](https://digital.nhs.uk/services/pathology-standards-and-implementation/snomed-ct-for-pathology-reporting))\ndo not cover Histocompatibility and Immunogenetics (H&I) order entry specifically. The\nrelevant national body is **NHS Blood and Transplant (NHSBT)**, not NHS England: its\n[INF136 "User Guide for Histocompatibility and Immunogenetics Diagnostics\nServices"](https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/29939/inf136.pdf)\ndefines six national H&I request forms (Table 2) including `FRM1008` "H&I Organ\nTransplant (Patients and Donors)" and `FRM1010` "H&I Haematopoietic Stem Cell\nTransplantation (Recipients & Donors)", plus a sample-requirements table listing\n"HLA type of **patient, donors or family members**" for Solid Organ Transplantation -\nconfirming HLA Type is a fixed national list, not free text, even though NHSBT does not\npublish a FHIR/LOINC/SNOMED binding for it. NHSBT's Solid Organ Transplantation section\n(4.5.1) also describes 24-hour on-call cover for "**renal** and, where appropriate,\n**cardiothoracic** transplantation", with liver/other transplant types noted separately\nas not having HLA match as a primary factor - consistent with Patient Type being a\nsmall, fixed list. The professional bodies **BSHI** (British Society for\nHistocompatibility and Immunogenetics) and **BTS** (British Transplantation Society)\njointly publish clinical guidelines (e.g. the\n[2015 BTS/BSHI antibody characterisation guideline](https://bts.org.uk/wp-content/uploads/2016/09/06_BTS_BSHI_Antibodies-1.pdf))\nbut not data/interoperability standards. This IG's own dependency,\n[HL7's Genomics Reporting IG - Histocompatibility and Immunogenetic\nReporting](http://hl7.org/fhir/uv/genomics-reporting/histocompatibility.html), profiles\nstructured HLA genotype/haplotype *results* (LOINC `84413-4` Genotype display name,\n`48018-6` Gene studied, `13298-5` HLA-A [Type], the GL String and HGNC systems) but does\nnot address order-entry "ask at order" questions like these. See each item below for\nLOINC panels and UK code lists relevant to that specific question.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Questionnaire</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">https://fhir.nwgenomics.nhs.uk/Questionnaire/HLATestsTransplantAskAtOrderEntry#2.2.5</td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck01.png)\" id=\"item.AskAtOrderEntry\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> AskAtOrderEntry</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Ask At Order Entry Questions</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck011.png)\" id=\"item.HistoIG/patient_test\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / </span>HistoIG/patient_test</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Patient Test(s)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Definition: <a href=\"http://hl7.org/fhir/R4/servicerequest.html#ServiceRequest.orderDetail\">ServiceRequest.orderDetail</a><br/>Options: <a href=\"#opt-item.HistoIG/patient_test\">5 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck0110.png)\" id=\"item.HistoIG/patient_test-designNote\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/patient_test / </span>HistoIG/patient_test-designNote</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Histotrac NTE-3 (CommentType=OSQ): restates the OBR-4 test name. Mapped to\n`ServiceRequest.orderDetail` rather than `ServiceRequest.code` - the base\n[Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own Test Code item\nalready targets `ServiceRequest.code` (single-cardinality), so reusing it here\nwould conflict with no `enableWhen` to say which item wins.\n`ServiceRequest.orderDetail` is repeating and intended for exactly this kind of\nfurther order qualifier, and matches this item's own `repeats = true` (the Hive\nUI presents them as checkboxes - more than one may be selected per order).\nConfirmed as this fixed 5-value checklist from the Hive/Histotrac order-entry UI,\nshown identically regardless of Patient Type (Stem cell or Renal) - coded against\nthe [Histotrac](CodeSystem-Histotrac.html) CodeSystem (the order-detail\nrestatement codes Histotrac itself uses alongside its Test Code, bound via\n[HistotracOrderDetail](ValueSet-HistotracOrderDetail.html)) - rather than the\nlocal `NWGMSA` codes the Hive order-entry UI's own checkboxes use for the\norder-entry *selection* itself. [Chimerism Test Additional Ask At Order Entry\nQuestions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html) used to\nfollow the same `patient_test` pattern, since dropped - see\n[Outstanding Issues](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#outstanding-issues)\nitem 7.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck0100.png)\" id=\"item.HistoIG/patient_test-reference\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/patient_test / </span>HistoIG/patient_test-reference</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">No MFT/NHS England code set was found for these five specific test names, but\nLOINC has panels the Histotrac test catalogue could map onto if a coded\nalternative to the `Histotrac` codes is wanted: 102092-4 (HLA-ABDR typing\npanel), 96615-0/96629-1 (HLA-A/B/C class I typing, high/low resolution), 94492-6\n(HLA-DQA1/DQB1 typing), 72905-3 (Neutrophil Ab and HLA Ab screen panel), 94428-0\n(HLA class I and II IgG panel), and 80737-0 (Calculated panel reactive antibody).\nNot the NHS England Genomic Test Directory (England-GenomicTestDirectory) - H&I is\nnot part of that catalogue.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck011.png)\" id=\"item.HistoIG/hla_type\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / </span>HistoIG/hla_type</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">HLA Type</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Definition: <a href=\"http://hl7.org/fhir/R4/observation.html#Observation.valueCodeableConcept\">Observation.valueCodeableConcept</a><br/>Options: <a href=\"#opt-item.HistoIG/hla_type\">2 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck0110.png)\" id=\"item.HistoIG/hla_type-designNote\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/hla_type / </span>HistoIG/hla_type-designNote</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Whose HLA is being typed - carried as an Observation referenced from\nServiceRequest.supportingInfo, the same Ask at Order Entry pattern used by\ndWGS's Family Structure/Participant Type. Confirmed as a 2-value list (Patient,\nDonor) from the Hive/Histotrac order-entry UI screenshots - coded locally\nagainst the `NWGMSA` CodeSystem as no NHSBT/NHS England-published\nFHIR/LOINC/SNOMED binding exists.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck0100.png)\" id=\"item.HistoIG/hla_type-reference\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/hla_type / </span>HistoIG/hla_type-reference</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">NHSBT's INF136 (Table 2) names a national request form "H&I Organ Transplant\n(Patients and Donors)" (FRM1008), and its sample-requirements table lists "HLA\ntype of patient, donors or family members" for Solid Organ Transplantation -\nwider than the Patient/Donor pair the Hive UI actually offers. A separate\nnational form, "H&I Haematopoietic Stem Cell Transplantation (Recipients &\nDonors)" (FRM1010), uses Recipient/Donor instead of Patient/Donor for that\ntransplant type. No NHSBT-published FHIR/LOINC/SNOMED binding exists for either,\nand Hive does not appear to expose a Family Member/Recipient option here.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck011.png)\" id=\"item.HistoIG/patient_type\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / </span>HistoIG/patient_type</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Patient Type</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Definition: <a href=\"http://hl7.org/fhir/R4/observation.html#Observation.valueCodeableConcept\">Observation.valueCodeableConcept</a><br/>Options: <a href=\"#opt-item.HistoIG/patient_type\">3 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck0110.png)\" id=\"item.HistoIG/patient_type-designNote\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/patient_type / </span>HistoIG/patient_type-designNote</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Transplant context - carried as an Observation referenced from\nServiceRequest.supportingInfo. Confirmed as a 3-value list (Stem cell, Renal,\nThoracic) from the Hive/Histotrac order-entry UI - coded locally against the\n`NWGMSA` CodeSystem. When Patient Type is "Renal" the Hive UI also shows an\nOrgan picker (see `HistoIG/organ` below); no Organ field is shown for Stem\ncell/Thoracic.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck0100.png)\" id=\"item.HistoIG/patient_type-reference\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/patient_type / </span>HistoIG/patient_type-reference</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">NHSBT's INF136 (4.5.1) describes 24-hour on-call cover for "renal and, where\nappropriate, cardiothoracic transplantation" as the two Solid Organ\nTransplantation categories with routine H&I on-call support, and the Hive UI's\n"Thoracic" option lines up with that "cardiothoracic" wording (not "Cardiac").\nStem cell is a third category the Hive UI groups here rather than treating as a\nseparate transplant type. No NHSBT/NHS England LOINC/SNOMED binding was found\nfor this field.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck011.png)\" id=\"item.HistoIG/organ\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / </span>HistoIG/organ</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Organ</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Definition: <a href=\"http://hl7.org/fhir/R4/specimen.html#Specimen.collection.bodySite\">Specimen.collection.bodySite</a><br/>Options: <a href=\"#opt-item.HistoIG/organ\">5 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck0110.png)\" id=\"item.HistoIG/organ-designNote\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/organ / </span>HistoIG/organ-designNote</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">The organ relevant to the transplant - the body site the specimen was collected\nfrom. Confirmed as this 5-value list (plus a free-text\n"Other" box, not modelled here) from the Hive/Histotrac order-entry UI, only shown\nthere when Patient Type is "Renal". The three single-organ values (Kidney,\nPancreas, Islets) are now coded against SNOMED CT from the FHIR [body-site value\nset](https://hl7.org/fhir/R4/valueset-body-site.html) - `64033007` "Kidney\nstructure", `15776009` "Pancreatic structure", and `78696007` "Endocrine\npancreatic structure" for Islets (the closest single body-structure concept to\n"Islets of Langerhans" available - islet tissue is the endocrine pancreas, there\nis no separate discrete "Islet of Langerhans structure" concept). The two\n"Simultaneous..." combination transplants remain coded against `NWGMSA`, since\nneither is itself a single SNOMED CT body-site concept.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck0100.png)\" id=\"item.HistoIG/organ-reference\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/organ / </span>HistoIG/organ-reference</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">NHS Digital's UK-specific "Solid organ transplant codes" (ORGTRANSP_COD)\nreference set (part of the NHS Digital Primary Care Domain Refsets, ~364 codes,\nhttps://www.opencodelists.org/codelist/nhsd-primary-care-domain-refsets/orgtransp_cod/)\nremains a candidate alternative binding, not adopted here since it is a UK\nreference set rather than the FHIR body-site value set the SNOMED CT codes above\nare drawn from. Neither source has a single code for a combination transplant\nsuch as "Simultaneous Pancreas/Kidney", which is why those two remain local\n`NWGMSA` codes rather than SNOMED CT.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck001.png)\" id=\"item.HistoIG/specimen_source\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / </span>HistoIG/specimen_source</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Specimen Source</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Definition: <a href=\"http://hl7.org/fhir/R4/specimen.html#Specimen.type.coding.code\">Specimen.type.coding.code</a><br/>Options: <a href=\"#opt-item.HistoIG/specimen_source\">3 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck0010.png)\" id=\"item.HistoIG/specimen_source-designNote\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/specimen_source / </span>HistoIG/specimen_source-designNote</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Confirmed as this 3-value list (Blood, Buccal, plus a free-text "Other" box, not\nmodelled here) from the Hive/Histotrac order-entry UI's HLA panel - narrower than\nthe EU/UK/NW-compatible [Specimen Type](ValueSet-specimen-type.html) value set\npreviously bound here (`answerValueSet = Canonical(SpecimenType)`). Blood and\nBuccal are now coded against SNOMED CT codes drawn from that same [Specimen\nType](ValueSet-specimen-type.html) value set - `119297000` "Blood specimen" and\n`733104004` "Swab from buccal mucosa" - the same `119297000` code [Chimerism Test\nAdditional Ask At Order Entry\nQuestions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html)'s own\n`ChimIG/specimen_source` item uses for its "Blood (PB)" option. Other remains a\nlocal `NWGMSA` code, since [Specimen Type](ValueSet-specimen-type.html) has no\nsingle generic "other/unspecified" concept to match Hive's free-text catch-all.\nDeliberately given its own `HistoIG/specimen_source` linkId rather than reusing\nthe base [Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own\n`LN/66746-9` Specimen Type item (same `code`/LOINC `66746-9`, so the semantic link\nis kept via `code`) - the two questions are asked at different points for\ndifferent purposes in Hive, and the IG Publisher's Questionnaire derivation\nvalidator does not support a `derivedFrom`/`extends` item reusing a base item's\nlinkId while also declaring more than one `answerOption`.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck0000.png)\" id=\"item.HistoIG/specimen_source-reference\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">AskAtOrderEntry / HistoIG/specimen_source / </span>HistoIG/specimen_source-reference</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">NHSBT's INF136 Table 5 (sample requirements) shows nearly every H&I test uses\nperipheral blood (EDTA and/or clotted, varying by test), with spleen/lymph node\nas the exception for deceased-donor crossmatching - consistent with Hive's Blood\noption. No dedicated NHS-published specimen-type binding specific to H&I was\nfound; the generic [Specimen Type](ValueSet-specimen-type.html) SNOMED CT codes\nabove are used instead for Blood/Buccal.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name=\"opt-item.HistoIG/patient_test\"> </a><p><b>Answer options for HistoIG/patient_test </b></p><ul><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLATypingAntibodyScreening ("HLA Typing + Antibody Screening")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLAAntibodyScreening ("HLA Antibody Screening")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLATypeRecipient ("HLA Type Recipient")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#DSA ("DSA")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLAAutoXM ("HLA Auto XM")</li></ul><a name=\"opt-item.HistoIG/hla_type\"> </a><p><b>Answer options for HistoIG/hla_type </b></p><ul><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Patient ("Patient")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Donor ("Donor")</li></ul><a name=\"opt-item.HistoIG/patient_type\"> </a><p><b>Answer options for HistoIG/patient_type </b></p><ul><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#StemCell ("Stem cell")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Renal ("Renal")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Thoracic ("Thoracic")</li></ul><a name=\"opt-item.HistoIG/organ\"> </a><p><b>Answer options for HistoIG/organ </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#64033007 ("Kidney structure")</li><li style=\"font-size: 11px\">http://snomed.info/sct#15776009 ("Pancreatic structure")</li><li style=\"font-size: 11px\">http://snomed.info/sct#78696007 ("Endocrine pancreatic structure")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#SimultaneousPancreasKidney ("Simultaneous Pancreas/Kidney")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#SimultaneousIsletKidney ("Simultaneous Islet/Kidney")</li></ul><a name=\"opt-item.HistoIG/specimen_source\"> </a><p><b>Answer options for HistoIG/specimen_source </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#119297000 ("Blood specimen")</li><li style=\"font-size: 11px\">http://snomed.info/sct#733104004 ("Swab from buccal mucosa")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#HistoOther ("Other")</li></ul></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
"valueCoding" : {
"system" : "http://hl7.org/fhir/version-algorithm",
"code" : "semver"
}
}
],
"url" : "https://fhir.nwgenomics.nhs.uk/Questionnaire/HLATestsTransplantAskAtOrderEntry",
"version" : "2.2.5",
"title" : "HLA Tests - Transplant Ask At Order Entry",
"derivedFrom" : [
🔗 "https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder|2.2.5"
],
"_derivedFrom" : [
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType",
"valueCoding" : {
"system" : "http://hl7.org/fhir/questionnaire-derivationType",
"code" : "extends"
}
}
]
}
],
"status" : "draft",
"date" : "2026-11-05T06:40:21+00:00",
"publisher" : "NHS North West Genomics",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://www.nwgenomics.nhs.uk/contact-us"
}
]
}
],
"description" : "**Ask At Order Entry Questions** used alongside the [common core order\nform](StructureDefinition-GenomicTestOrder.html) for the \"HLA Tests - Transplant\" order\nscreen within Histocompatibility and Immunogenetics orders (SNOMED CT\n`909871000000100`) - see\n[Order Entry Questions](StructureDefinition-GenomicTestOrder.html#order-entry-questions) and\n[Histocompatibility and Immunogenetics](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions).\nFor the sibling Chimerism testing order screen, see\n[Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html).\n\nExtracted from the `NTE` segments (each carrying HL7 v2 Table 0105-style comment type\n`OSQ`) of a live Histotrac `ORM^O01` order - see the worked\n[example](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions) for the\nfull message. Each `NTE-3` value uses a local `Label:->Value` convention (e.g.\n`HLA Type:->Patient`), split below into a question/answer pair.\n\n**Research summary (no NHS England-published order-comms/interoperability standard was\nfound for these fields)**: NHS England's published pathology standards\n([Pathology Test and Results Standard](https://standards.nhs.uk/published-standards/pathology-test-and-results-standard),\n[SNOMED CT for pathology reporting](https://digital.nhs.uk/services/pathology-standards-and-implementation/snomed-ct-for-pathology-reporting))\ndo not cover Histocompatibility and Immunogenetics (H&I) order entry specifically. The\nrelevant national body is **NHS Blood and Transplant (NHSBT)**, not NHS England: its\n[INF136 \"User Guide for Histocompatibility and Immunogenetics Diagnostics\nServices\"](https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/29939/inf136.pdf)\ndefines six national H&I request forms (Table 2) including `FRM1008` \"H&I Organ\nTransplant (Patients and Donors)\" and `FRM1010` \"H&I Haematopoietic Stem Cell\nTransplantation (Recipients & Donors)\", plus a sample-requirements table listing\n\"HLA type of **patient, donors or family members**\" for Solid Organ Transplantation -\nconfirming HLA Type is a fixed national list, not free text, even though NHSBT does not\npublish a FHIR/LOINC/SNOMED binding for it. NHSBT's Solid Organ Transplantation section\n(4.5.1) also describes 24-hour on-call cover for \"**renal** and, where appropriate,\n**cardiothoracic** transplantation\", with liver/other transplant types noted separately\nas not having HLA match as a primary factor - consistent with Patient Type being a\nsmall, fixed list. The professional bodies **BSHI** (British Society for\nHistocompatibility and Immunogenetics) and **BTS** (British Transplantation Society)\njointly publish clinical guidelines (e.g. the\n[2015 BTS/BSHI antibody characterisation guideline](https://bts.org.uk/wp-content/uploads/2016/09/06_BTS_BSHI_Antibodies-1.pdf))\nbut not data/interoperability standards. This IG's own dependency,\n[HL7's Genomics Reporting IG - Histocompatibility and Immunogenetic\nReporting](http://hl7.org/fhir/uv/genomics-reporting/histocompatibility.html), profiles\nstructured HLA genotype/haplotype *results* (LOINC `84413-4` Genotype display name,\n`48018-6` Gene studied, `13298-5` HLA-A [Type], the GL String and HGNC systems) but does\nnot address order-entry \"ask at order\" questions like these. See each item below for\nLOINC panels and UK code lists relevant to that specific question.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "GB",
"display" : "United Kingdom of Great Britain and Northern Ireland"
}
]
}
],
"item" : [
{
"linkId" : "AskAtOrderEntry",
"text" : "Ask At Order Entry Questions",
"type" : "group",
"item" : [
{
"linkId" : "HistoIG/patient_test",
"definition" : "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.orderDetail",
"text" : "Patient Test(s)",
"type" : "choice",
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac",
"code" : "HLATypingAntibodyScreening",
"display" : "HLA Typing + Antibody Screening"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac",
"code" : "HLAAntibodyScreening",
"display" : "HLA Antibody Screening"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac",
"code" : "HLATypeRecipient",
"display" : "HLA Type Recipient"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac",
"code" : "DSA",
"display" : "DSA"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac",
"code" : "HLAAutoXM",
"display" : "HLA Auto XM"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/patient_test-designNote",
"text" : "Histotrac NTE-3 (CommentType=OSQ): restates the OBR-4 test name. Mapped to\n`ServiceRequest.orderDetail` rather than `ServiceRequest.code` - the base\n[Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own Test Code item\nalready targets `ServiceRequest.code` (single-cardinality), so reusing it here\nwould conflict with no `enableWhen` to say which item wins.\n`ServiceRequest.orderDetail` is repeating and intended for exactly this kind of\nfurther order qualifier, and matches this item's own `repeats = true` (the Hive\nUI presents them as checkboxes - more than one may be selected per order).\nConfirmed as this fixed 5-value checklist from the Hive/Histotrac order-entry UI,\nshown identically regardless of Patient Type (Stem cell or Renal) - coded against\nthe [Histotrac](CodeSystem-Histotrac.html) CodeSystem (the order-detail\nrestatement codes Histotrac itself uses alongside its Test Code, bound via\n[HistotracOrderDetail](ValueSet-HistotracOrderDetail.html)) - rather than the\nlocal `NWGMSA` codes the Hive order-entry UI's own checkboxes use for the\norder-entry *selection* itself. [Chimerism Test Additional Ask At Order Entry\nQuestions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html) used to\nfollow the same `patient_test` pattern, since dropped - see\n[Outstanding Issues](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#outstanding-issues)\nitem 7.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/patient_test-reference",
"text" : "No MFT/NHS England code set was found for these five specific test names, but\nLOINC has panels the Histotrac test catalogue could map onto if a coded\nalternative to the `Histotrac` codes is wanted: 102092-4 (HLA-ABDR typing\npanel), 96615-0/96629-1 (HLA-A/B/C class I typing, high/low resolution), 94492-6\n(HLA-DQA1/DQB1 typing), 72905-3 (Neutrophil Ab and HLA Ab screen panel), 94428-0\n(HLA class I and II IgG panel), and 80737-0 (Calculated panel reactive antibody).\nNot the NHS England Genomic Test Directory (England-GenomicTestDirectory) - H&I is\nnot part of that catalogue.",
"type" : "display"
}
]
},
{
"linkId" : "HistoIG/hla_type",
"definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept",
"text" : "HLA Type",
"type" : "choice",
"required" : true,
"answerOption" : [
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "Patient",
"display" : "Patient"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "Donor",
"display" : "Donor"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/hla_type-designNote",
"text" : "Whose HLA is being typed - carried as an Observation referenced from\nServiceRequest.supportingInfo, the same Ask at Order Entry pattern used by\ndWGS's Family Structure/Participant Type. Confirmed as a 2-value list (Patient,\nDonor) from the Hive/Histotrac order-entry UI screenshots - coded locally\nagainst the `NWGMSA` CodeSystem as no NHSBT/NHS England-published\nFHIR/LOINC/SNOMED binding exists.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/hla_type-reference",
"text" : "NHSBT's INF136 (Table 2) names a national request form \"H&I Organ Transplant\n(Patients and Donors)\" (FRM1008), and its sample-requirements table lists \"HLA\ntype of patient, donors or family members\" for Solid Organ Transplantation -\nwider than the Patient/Donor pair the Hive UI actually offers. A separate\nnational form, \"H&I Haematopoietic Stem Cell Transplantation (Recipients &\nDonors)\" (FRM1010), uses Recipient/Donor instead of Patient/Donor for that\ntransplant type. No NHSBT-published FHIR/LOINC/SNOMED binding exists for either,\nand Hive does not appear to expose a Family Member/Recipient option here.",
"type" : "display"
}
]
},
{
"linkId" : "HistoIG/patient_type",
"definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept",
"text" : "Patient Type",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "StemCell",
"display" : "Stem cell"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "Renal",
"display" : "Renal"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "Thoracic",
"display" : "Thoracic"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/patient_type-designNote",
"text" : "Transplant context - carried as an Observation referenced from\nServiceRequest.supportingInfo. Confirmed as a 3-value list (Stem cell, Renal,\nThoracic) from the Hive/Histotrac order-entry UI - coded locally against the\n`NWGMSA` CodeSystem. When Patient Type is \"Renal\" the Hive UI also shows an\nOrgan picker (see `HistoIG/organ` below); no Organ field is shown for Stem\ncell/Thoracic.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/patient_type-reference",
"text" : "NHSBT's INF136 (4.5.1) describes 24-hour on-call cover for \"renal and, where\nappropriate, cardiothoracic transplantation\" as the two Solid Organ\nTransplantation categories with routine H&I on-call support, and the Hive UI's\n\"Thoracic\" option lines up with that \"cardiothoracic\" wording (not \"Cardiac\").\nStem cell is a third category the Hive UI groups here rather than treating as a\nseparate transplant type. No NHSBT/NHS England LOINC/SNOMED binding was found\nfor this field.",
"type" : "display"
}
]
},
{
"linkId" : "HistoIG/organ",
"definition" : "http://hl7.org/fhir/StructureDefinition/Specimen#Specimen.collection.bodySite",
"text" : "Organ",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "64033007",
"display" : "Kidney structure"
}
},
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "15776009",
"display" : "Pancreatic structure"
}
},
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "78696007",
"display" : "Endocrine pancreatic structure"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "SimultaneousPancreasKidney",
"display" : "Simultaneous Pancreas/Kidney"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "SimultaneousIsletKidney",
"display" : "Simultaneous Islet/Kidney"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/organ-designNote",
"text" : "The organ relevant to the transplant - the body site the specimen was collected\nfrom. Confirmed as this 5-value list (plus a free-text\n\"Other\" box, not modelled here) from the Hive/Histotrac order-entry UI, only shown\nthere when Patient Type is \"Renal\". The three single-organ values (Kidney,\nPancreas, Islets) are now coded against SNOMED CT from the FHIR [body-site value\nset](https://hl7.org/fhir/R4/valueset-body-site.html) - `64033007` \"Kidney\nstructure\", `15776009` \"Pancreatic structure\", and `78696007` \"Endocrine\npancreatic structure\" for Islets (the closest single body-structure concept to\n\"Islets of Langerhans\" available - islet tissue is the endocrine pancreas, there\nis no separate discrete \"Islet of Langerhans structure\" concept). The two\n\"Simultaneous...\" combination transplants remain coded against `NWGMSA`, since\nneither is itself a single SNOMED CT body-site concept.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/organ-reference",
"text" : "NHS Digital's UK-specific \"Solid organ transplant codes\" (ORGTRANSP_COD)\nreference set (part of the NHS Digital Primary Care Domain Refsets, ~364 codes,\nhttps://www.opencodelists.org/codelist/nhsd-primary-care-domain-refsets/orgtransp_cod/)\nremains a candidate alternative binding, not adopted here since it is a UK\nreference set rather than the FHIR body-site value set the SNOMED CT codes above\nare drawn from. Neither source has a single code for a combination transplant\nsuch as \"Simultaneous Pancreas/Kidney\", which is why those two remain local\n`NWGMSA` codes rather than SNOMED CT.",
"type" : "display"
}
]
},
{
"linkId" : "HistoIG/specimen_source",
"definition" : "http://hl7.org/fhir/StructureDefinition/Specimen#Specimen.type.coding.code",
"code" : [
{
"system" : "http://loinc.org",
"code" : "66746-9",
"display" : "Specimen Type"
},
{
"system" : "http://snomed.info/sct",
"code" : "123038009",
"display" : "Specimen"
}
],
"text" : "Specimen Source",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "119297000",
"display" : "Blood specimen"
}
},
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "733104004",
"display" : "Swab from buccal mucosa"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "HistoOther",
"display" : "Other"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/specimen_source-designNote",
"text" : "Confirmed as this 3-value list (Blood, Buccal, plus a free-text \"Other\" box, not\nmodelled here) from the Hive/Histotrac order-entry UI's HLA panel - narrower than\nthe EU/UK/NW-compatible [Specimen Type](ValueSet-specimen-type.html) value set\npreviously bound here (`answerValueSet = Canonical(SpecimenType)`). Blood and\nBuccal are now coded against SNOMED CT codes drawn from that same [Specimen\nType](ValueSet-specimen-type.html) value set - `119297000` \"Blood specimen\" and\n`733104004` \"Swab from buccal mucosa\" - the same `119297000` code [Chimerism Test\nAdditional Ask At Order Entry\nQuestions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html)'s own\n`ChimIG/specimen_source` item uses for its \"Blood (PB)\" option. Other remains a\nlocal `NWGMSA` code, since [Specimen Type](ValueSet-specimen-type.html) has no\nsingle generic \"other/unspecified\" concept to match Hive's free-text catch-all.\nDeliberately given its own `HistoIG/specimen_source` linkId rather than reusing\nthe base [Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own\n`LN/66746-9` Specimen Type item (same `code`/LOINC `66746-9`, so the semantic link\nis kept via `code`) - the two questions are asked at different points for\ndifferent purposes in Hive, and the IG Publisher's Questionnaire derivation\nvalidator does not support a `derivedFrom`/`extends` item reusing a base item's\nlinkId while also declaring more than one `answerOption`.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "HistoIG/specimen_source-reference",
"text" : "NHSBT's INF136 Table 5 (sample requirements) shows nearly every H&I test uses\nperipheral blood (EDTA and/or clotted, varying by test), with spleen/lymph node\nas the exception for deceased-donor crossmatching - consistent with Hive's Blood\noption. No dedicated NHS-published specimen-type binding specific to H&I was\nfound; the generic [Specimen Type](ValueSet-specimen-type.html) SNOMED CT codes\nabove are used instead for Blood/Buccal.",
"type" : "display"
}
]
}
]
}
]
}