NHS North West Genomics - Local Development build (v2.1.4) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

ServiceRequest Introduction

Reference

• HL7 Europe Laboratory Report - ServiceRequest: Laboratory Order
• HL7 Europe ServiceRequest: Laboratory Order
• NHS England Genomics ServiceRequest use text descriptions only, not the rendered profile.
• NHS Genomic Medicine Service test order forms
• NHS England FHIR Genomics Implementation Guide—Clinical Headings
• Prior Results (Oncology)
  • HL7 USA minimal Common Oncology Data Elements (mCODE) Implementation Guide - Assessment

Domain Archetype

Genomic Test Order Sections

Diagnostic Order

Order Test Form - Data Extraction Overview

The FHIR exchange style used FHIR Message following laboratory-order message definition. This definition is based on HL7 v2 OML_O21 Laboratory Order which simplifies conversion to/from pipe+hat (v2) and json (FHIR) formats.

At present, the NW GLH Laboratory Information Management System (LIMS) will not support HL7 FHIR. The Regional Integration Exchange (RIE) will perform conversion between v2 and FHIR formats.

This message is an aggregate (DDD)/archetype and so is a collection of FHIR Resources (similar to v2 segements) which is described in Genomic Test Order.

Communicating Ask at Order Entry questions and prior results

See also HL7 Europe Laboratory Report - ServiceRequest This message can be extended by template (FHIR Questionnaire) which allows the definition of additional questions to be defined for the laboratory order.

The detail of this form/template defines:

Order Text Form Example (extract)

Question	CodeSystem	Code	FHIR Profile	HL7 v2 Segment	FHIR Questionniare item.type	FHIR Observation value[x]	v2 OBX-2
Does This Test Relate to a Pregnancy	SNOMED	77386006	Observation	OBX	boolean	valueBoolean	CE (code 0136)
Sample	LOINC	68992-7	Observation-Panel	OBR
High Infection Risk Sample	SNOMED	281269004	Observation	OBX	boolean	valueBoolean	CE (code 0136)

It is not expected the NW GLH Laboratory Information Management System (LIMS) will support UK SNOMED CT, and the RIE will handle the conversion either internally using FHIR ConceptMap or a terminology service with the following capabilities IHE Sharing Valuesets, Codes, and Maps (SVCM)

Patient Demographics

Name	Value Set / Data Type	Cardinality	HL7 v2 OML_O21 Message	HL7 FHIR ServiceRequest	HL7 FHIR Resource (Message + RESTful)
NHS Number	NHS Number	0..1	PID-3	ServiceRequest.subject.identifier	Patient.identifier[nhsNumber]
Medical Record Number	Medical Record Number	0..1	PID-3	if NHS Number not present ServiceRequest.subject.identifier	Patient.identifier[MedicalRecordNumber]
Date of Birth	​Date of Birth	0..1	PID-7		Patient.birthDate
Postcode	​Postcode	0..1	PID-11		Patient.address.postalCode

Hospital Spell

Treat as mandatory for reflex or subcontracted orders.

Name	Value Set / Data Type	Cardinality	HL7 v2 OML_O21 Message	HL7 FHIR ServiceRequest	HL7 FHIR Resource (Message + RESTful)
Hospital Service	Service	0..1	PV1-10		Encounter.serviceType
Case Identification or Account Number	HospitalProviderSpellIdentifier	0..1	PV1-19	ServiceRequest.encounter.identifier	Encounter.identifier HospitalSpell

Diagnostic Workflow

Name	Value Set / Data Type	Cardinality	HL7 v2 OML_O21 Message	HL7 FHIR ServiceRequest
Order Identifier (Placer)	Order Identifier	1..1	ORC-2	ServiceRequest.identifier[OrderIdentifier]
Filler Order Number		0..1	ORC-3	ServiceRequest.identifier[OrderFillerNumber]
(Placer) Order Group Number	Order Group Number	0..1	ORC-4	ServiceRequest.requisition.identifier
(Order) Procedure Code	Diagnostic Domain specific - See below	1..1	OBR-4	ServiceRequest.code
Order date		0..1	ORC-9	ServiceRequest.authoredOn
Ordering Practitioner	England Practitioner Identifier	0..1	ORC-12	ServiceRequest.requester[PractitionerRole]
Ordering Facility	Organisation Code	1..1	ORC-21	If Order has requesting practitioner ServiceRequest.requester[PractitionerRole] else ServiceRequest.requester[Organization]
performer	Organisation Code	0..1	implied by destination of message	ServiceRequest.performer
Suspected Condition	Domain specific - See below (Generally SNOMED Condition code)	..	DG1-3	ServiceRequest.reasonCode
Supporting Information	Domain specific - See below	0..*	OBX	ServiceRequest.supportingInformation
Notes		0..*	NTE	ServiceRequest.note
Specimen	See Specimen below	0..*	SPM	ServiceRequest.specimen.identifier

Diagnostic Genomics

Name	Value Set / Data Type	Cardinality	HL7 v2 OML_O21 Message	HL7 FHIR ServiceRequest
(Order) Procedure Code - Genomic Test Code	Genomic Test Directory	1..1	OBR-4	ServiceRequest.code

Order Entry Questions

Specimen

Name	LOINC	Value Set / Data Type	Cardinality	HL7 v2 OML_O21 Message	HL7 FHIR ServiceRequest
Specimen ID	80398-1		0..*		ServiceRequest.specimen

Note: it is likely that source systems will use ORM_01 and not include specimen details. In this case it is suggested that the specimen details are captured as 'Ask at Order Entry Questions' and so provided as OBX segments.