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

Diagnostic Core

This implementation guide primarily focuses on the Diagnostic Workflow and how it integrates within the broader health data model, as illustrated in the diagram above.

• Patient Care and Patient Administration are typically found in NHS providers Electronic Patient Record systems
• Care Directory Service on the other hand, are centrally defined by NHS England, with supporting APIs also provided by NHS England (for example, the ODS API).

In software design, these areas are often referred to as domains. The Genomic Diagnostic Workflow operates across several of these domains — in software architecture terms, this is known as a bounded context.

Diagnostic Workflow - MindMap

Entity Relationship Diagram

erDiagram

  OriginalOrder ||--|{ FillerOrder : "has (FillerOrderNumber = FillerGroupNumber)"
  OriginalOrder ||--|{ Specimen : contains
  FillerOrder ||--|{ Specimen : contains
  Patient ||--|{ OriginalOrder : "NHSNumber or PatientAccessionIdentifier"
  Patient ||--|{ FillerOrder : "NHSNumber or PatientAccessionIdentifier" 
  Patient ||--|{ DiagnosticReport : "NHSNumber or PatientAccessionIdentifier" 
  OriginalOrder ||--|{ DiagnosticReport : contains
  HospitalSpell ||--|{ OriginalOrder : "HospitalSpellProviderIdentifier"
  HospitalSpell ||--|{ FillerOrder : "HospitalSpellProviderIdentifier" 
  HospitalSpell ||--|{ DiagnosticReport : "HospitalSpellProviderIdentifier" 

  OriginalOrder {
    identifier PlacerOrderNumber
    identifier FillerOrderNumber
    code NGTDTestCode
    code RequestingOrganisationCode
    reference Specimen
    reference Patient
     reference HospitalSpellProviderIdentifier
  }

  FillerOrder {
    code OrderStatus
    date TestOrderDate
    identifier TestAccessionIdentifier
    code NGTDTestCode
    string ClinicalDetails
    code Performer
    reference Specimen
    reference Patient
    reference OriginalOrder
     reference HospitalSpellProviderIdentifier
  }

  Patient {
    identifier NHSNumber
    identifier HospitalNumber
    identifier PatientAccessionIdentifier
    string PatientGivenName
    string PatientFamilyName
    date DateOfBirth
    string PostCode
    code AdministrativeSex
  }

  Specimen {
    identifier SpecimenAccessionIdentifier
    identifier ShipmentTrackingNumber
    identifier FMIIdentifier
    reference Patient
    code SpecimenTypeCode
    date SpecimenDispatchDate
    date SpecimenTakenDateTime
    date SpecimenReceivedDateTime
  }

  DiagnosticReport {
    identifier TestAccessionIdentifier
    reference FillerOrder
    reference Patient
    code NGTDTestCode
    date ReportStatusDateTime
    reference HospitalSpellProviderIdentifier
  }
  HospitalSpell {
    identifier HospitalSpellProviderIdentifier
  }

Patient

Type	Name	Description	FHIR Patient
identifier	NHSNumber	Primary patient identifier	Patient.identifier (type=NH)
identifier	HospitalNumber	Referring organisation local MRN identifier	Patient.identifier (type=MR)
identifier	PatientAccessionIdentifier	LIMS Patient identifier	Patient.identifier (type=PI)
string	PatientGivenName		Patient.name.given
string	PatientFamilyName		Patient.name.family
date	DateOfBirth		Patient.birthDate
code	AdministrativeSex		Patient.gender
string	PostCode		Patient.address.postalCode

Hospital Spell

Type	Name	Description	FHIR Hospital Spell
identifier	HospitalSpellProviderIdentifier	Identifier from ordering hospital	Encounter.identifier (type = AN)

Original Order

The original order is the order sent from the Order Placer to the Order Filler; in IHE Laboratory Testing Workflow this is the key entity in LAB-1

Type	Name	Description	FHIR ServiceRequest
identifier	PlacerOrderNumber		ServiceRequest.identifier (type = PLAC)
identifier	FillerOrderNumber		ServiceRequest.identifier (type = FILL)
code			ServiceRequest.intent (code = original-order)
code	Procedure Code - NGTDTestCode	NGTD code for test	ServiceRequest.code
string	ClinicalDetails	Referrer clinical notes	ServiceRequest.note
code	RequestingOrganisationCode	ODS code of requesting organisation	ServiceRequest.requester (ODS Code)
code	Performer		ServiceRequest.performer (fixed ODS code = 699X0)
reference	Specimen		ServiceRequest.specimen
reference	Patient		ServiceRequest.subject
reference	Hospital Spell		ServiceRequest.encounter (Hospital Spell)
code	Reason Code - Clinical Indication Code (CITT)		ServiceRequest.reasonCode

Filler Order

In IHE Laboratory Testing Workflow, this is the key entity in LAB-4

Type	Name	Description	FHIR ServiceRequest
code	OrderStatus	Order/test status	ServiceRequest.status
date	TestOrderDate		ServiceRequest.authoredOn
identifier	TestAccessionIdentifier		ServiceRequest.identifier
code	Procedure Code - NGTDTestCode	NGTD code for test	ServiceRequest.code
code	RequestingOrganisationCode	ODS code of requesting organisation	ServiceRequest.requester (fixed ODS code = 699X0)
code	Performer		ServiceRequest.performer (ODS Code)
reference	Specimen		ServiceRequest.specimen
reference	Patient		ServiceRequest.subject
reference	OriginalOrder		ServiceRequest.requisition and ServiceRequest.basedOn
reference	Hospital Spell		ServiceRequest.encounter (Hospital Spell)

Filler Order Intent

Type	Description	IHE PALM	Created by	Original Order Intent	Filler Order Intent
Laboratory Order	A request for one or more laboratory investigations submitted by the requesting clinician or system.	LAB-1	Order Placer	order / reflex
Work Order	A subordinate order created by the laboratory to organise and fulfil part of the overall Laboratory Order.	LAB-4	Order Filler		instance-order?
Subcontracted Order	A laboratory order forwarded to another laboratory for fulfilment, for example when a specialised test is referred to an external provider.	LAB-35	Order Filler		order (filler-order?)
Reflex Order	A new order created automatically by the Order Filler based on previous test results, for example when pathology findings automatically trigger a genomic test.	LAB-35	Order Filler		reflex

Specimen

Type	Name	Description	FHIR Specimen
identifier	SpecimenAccessionIdentifier		Specimen.identifier
identifier	ShipmentTrackingNumber	Courier tracking number	Specimen.identifier[ShipmentTrackingNumber] (type = STN)
identifier	FMIIdentifier		Specimen.container.identifier
reference	Patient		Specimen.subject
code	SpecimenTypeCode		Specimen.type
date	SpecimenDispatchDate
date	SpecimenTakenDateTime	Collection date/time	Specimen.collection.collectedDateTime
date	SpecimenReceivedDateTime	Received date/time

Diagnostic Report

This is the key entity for the reports/results which are generated when the Placer Order and Filler Order are fulfilled, which are LAB-3 and LAB-5 respectively.

Type	Name	Description	FHIR DiagnosticReport
identifier	TestAccessionIdentifier		DiagnosticReport.identifier
reference	FillerOrder		DiagnosticReport.basedOn (FillerOrder)
reference	Patient		DiagnosticReport.subject
code	Procedure Code - NGTDTestCode		DiagnosticReport.code (system = https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory)
date	ReportStatusDateTime		DiagnosticReport.effectiveDateTime
reference	Hospital Spell - Account Number		ServiceRequest.encounter (Hospital Spell)
code	Conclusion Code - Test Outcome Code
result	See Observations
presentedForm	See DocumentReference