NHS North West Genomics - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Report Options

Local/Regional Genomic Reports

Allows a consumer to retrieve genomic reports either as structured or unstructured

Unstructured Documents

Pattern: FHIR RESTful + IHE Mobile access to Health Documents (MHD)

sequenceDiagram
    participant Consumer As Document Consumer
    participant Repository As Document Registry and Repository

    Consumer ->> Repository: Query Document Metadata
    Repository -->> Consumer: List of DocumentReference
    Consumer ->> Consumer: Select Document entry
    Consumer ->> Repository: Retrieve Document (PDF)
    Repository -->> Consumer: PDF

Structured Data

Pattern: FHIR RESTful + IHE Query for Existing Data for Mobile (QEDm) also following HL7 Genomic Report

sequenceDiagram
    participant Consumer As Data Consumer
    participant Repository As Data Repository

    Consumer ->> Repository: Query Data (Diagnostic Report, Observation, etc)
    Repository -->> Consumer :FHIR Resources

Workflow + Messages

Note: most sharing of laboratory reports will be via HL7 v2 ORU_R01 messages to NHS Trusts and also Hl7 v2 MDM_T02 to ICS Shared Record Providers.

National Genomic Reports

Unstructured Documents

Pattern: FHIR RESTful + IHE Mobile Health Document Sharing - this is essentially the same as the local genomic reports but the registry is now a seperate service.

sequenceDiagram
    participant Consumer As Document Consumer
    participant Registry As Document Registry<br/>National Record Locator Service
    participant Repository As Document Repository

    Consumer ->> Registry: Query Document Metadata
    Registry -->> Consumer: List of DocumentReference
    Consumer ->> Consumer: Select Document entry
    Consumer ->> Repository: Retrieve Document (PDF)
    Repository -->> Consumer: PDF

Structured Data (Composition)

Pattern: FHIR RESTful + IHE Mobile Health Document Sharing - as above but the document is now a FHIR Document, probably HL7 Europe Laboratory Report combined with HL7 Genomic Report

sequenceDiagram
    participant Consumer As Document Consumer
    participant Registry As Document Registry<br/>National Record Locator Service
    participant Repository As Document Repository

    Consumer ->> Registry: Query Document Metadata
    Registry -->> Consumer: List of DocumentReference
    Consumer ->> Consumer: Select Document entry
    Consumer ->> Repository: Retrieve Document (FHIR Document)
    Repository -->> Consumer: FHIR Document

Technically this would likely be implemented as a aggregation using the local structured API's (this is how YHCR is implementing International Patient Summary which is also a FHIR Document) Unified Genomic Registry (UGR) has not decided on a specific option yet.

sequenceDiagram
    participant Consumer As Document Consumer
    participant Registry As Document Registry<br/>National Record Locator Service
    participant RepositoryFacade As Document Repository Facade
    participant Repository As Data Repository

    Consumer ->> Registry: Query Document Metadata
    Registry -->> Consumer: List of DocumentReference
    Consumer ->> Consumer: Select Document entry
    Consumer ->> RepositoryFacade: Retrieve Document (FHIR Document)
    RepositoryFacade ->> Repository: Query Data (Diagnostic Report, Observation, etc)
    Repository -->> RepositoryFacade:FHIR Resources
    RepositoryFacade ->> RepositoryFacade: Assemble FHIR Document
    RepositoryFacade -->> Consumer: FHIR Document

Workflow + Events

With the laboratory report shared, workflow can be altered to be event based. When a laboratory report is shared, a notification to the order placer and others who have subscribed to the event. This allows HL7 v2 ORU_R01 messages to be phased out.

Pattern: FHIR RESTful + IHE Document Subscription for Mobile (DSUBm)

Security Considerations

For local this would be using an OAuth2 Authorisation flow - see Authorisation (OAuth2) In addition all queries would be audited e.g. follow IHE Basic Audit Log Patterns (BALP)

For national, access to local repositories would be required would again use IHE BALP. The authentication is likely to be SSP Retrieval, this means the consumer does not talk directly to the repository.

sequenceDiagram
    participant Consumer As Document Consumer
    participant Registry As Document Registry<br/>National Record Locator Service
    participant SSP As Spine Secure Proxy
    participant Repository As Document Repository

    Consumer ->> Registry: Query Document Metadata
    Registry -->> Consumer: List of DocumentReference
    Consumer ->> Consumer: Select Document entry
    Consumer ->> SSP: Retrieve Document (PDF/FHIR Document)
    SSP ->> Repository: Retrieve Document (PDF/FHIR Document)
    Repository -->> SSP: PDF/FHIR Document
    SSP -->> Consumer: FHIR Document