DiagnosticOrder FHIR Resource Proposal

DiagnosticOrder

Owning committee name

Orders & Observations WG

Interested Work Groups

• Anatomic Pathology
• Clinical Genomics
• Imaging Integration
• Public Health and Emergency Response

FHIR Resource Development Project Insight ID

952

Scope of coverage

A Diagnostic Order is a record of a request for a set of diagnostic investigations to be performed. The investigation will lead to a Diagnostic Report that summarizes the outcome of the investigation, and includes any useful data and/or images that are relevant to the treatment/management of the subject.

The principal intention of the Diagnostic Order is to support ordering diagnostic investigations on patients and other subjects (which includes non-human patients in veterinary medicine.); however in many contexts, healthcare related processes include performing diagnostic investigations on groups of subjects, devices involved in the provision of healthcare, and even environmental locations such as ducts, bodies of water, etc. The Diagnostic Order supports all these usages.

The general work flow that this resource facilitates is that a clinical system creates a diagnostic order. The diagnostic order is then exchanged, perhaps via intermediaries, with a system that represents a diagnostic service that can perform or fulfill the investigation request. The diagnostic service will update the request as the work is performed, and then finally issue a report that references the requests that it fulfills.

Note that the Diagnostic Order itself is not a request to perform the investigation - it is just a record of the fact that a request was made, and the details of that request, which will be specific to the type of request. The Diagnostic Request must be paired with an Order resource to convey the actual instruction, or part of an explicit messaging or service workflow that carries the instruction. (Viewed the other way around, the Order resource has the workflow required to process the request, the DiagnosticOrder represents the content of the request. The Order resource supports other 'workflow' scenarios such as a prescription of a referral)

RIM scope

ActClass = OBS and children MoodCode = RQO

Resource appropriateness

Diagnostic orders are central to the business of healthcare. The basic process of healthcare is the diagnosis and treatment of patients. The diagnostic order is the primary means of allowing providers to request diagnostic services, in domains such as laboratory, radiology, pathology, etc.

Expected implementations

EMR systems that can create ann order for some diagnostic investigation to be performed, such as a blod test or a radiological examination.

Content sources

• HL7 v3 Laboratory Standard - Normative
• HL7 v2.x
• HL7 Radiology Report standards (for instance the DR Structured Report in C-CDA)

Example Scenarios

• a Clinician wants a blood test to be performed. Their EMR system creates a DiagnosticOrder resource that represents the tests they want to be performed. It also creates an Order resource that references the DiagnosticOrder resource and is used by the workflow infrastructure to ensure that the various processes are performed ( the blood is collected, sent to the lab etc.). When the test has been completed, then the lab will create a DiagnosticReport resource that will represent the result, and an OrderResponse resource that indicates that the order have been completed.

Resource Relationships

• Order
• OrderResponse
• DiagnosticReport
• Specimen
• Substance
• Supply
• ImagingStudy

Timelines

• Vote by WG (Ready for ballot): July 2013
• Ballot: September 2013

gForge Users

• Patrick Loyd
• Lorraine Constable