Result Event - tabular view

A Laboratory report is sent by a laboratory service provider to the laboratory service requester when some results are available. Reports and results may be In-progress or Completed. The report and its components are in fulfillment of a Placer Request. 

Indicates that this is an entry.

• Fixed value: "ENTRY"

Indicates that this is an event.

• Fixed value: "EVN"

A list of identifiers for this report.

The first (mandatory) identifier is a local identifier allocated by the originating system. It is made up of two parts, a root and extension. The Root will be an OID allocated to the system that generates the extension and will be at such a level that the combination of the Root and Extension is universally unique. The extension will be a human readable string generated by the system and may not be unique across the whole system.

E.g. There are many systems that are configured on a departmental basis and the same range of human readable strings are used in multiple departments. In such cases, the Root OID shall be allocated at such a level that the human readable portion is unique within that Root OID.

< id root =" 9.99.999.99.10.2 " extension ="0001192992 "/>

Where 9.99.999.99.  identifies the Hospital organization and 9.99.999.99.10.2 identifies the ID scheme within the Laboratory system that generated the extension.

The second identifier is for possible future use

Generally limited to 'Laboratory Report' unless the report is an Investigation Centric report on multiple specimens such as a Dynamic Function Test, Microbiology Bacterial Screen or a compound Microbiological procedure (C&S, Ova Cysts, Parasites) where each of the components will have a separate procedure and result.

It shall not carry any procedure concept ID with a pre-coordinated specimen type nor any specific procedure that carries a result and shall only be populated with a concept ID from the national subset of Investigations (SNOMED Lab Investigations Subset_UK_20060401) that represents a compound investigation including those that are performed on multiple specimens. 

The text (ED) attribute carries a CDA XML rendering of the Laboratory report. This shall only use CDA XML compliant xml tags and shall represent the Laboratory report as required by the sending system. The report shall represent all structured clinical data in the rest of the message payload and may represent information not carried as structured payload. The items that should be coded are identified in the W5. Provision is made for the carriage of embedded images within the report (See CDA XML definition in HL7 Ballot). It is recommended that the size of the image shall be restricted to that which would have been printed on the report at an appropriate resolution.

This identifies the status of the report.

Shall only be:- Active, Completed or Nullified.

Active reports shall be updated by a following report and are 'In-progress'. There may be multiple 'Active' reports prior to receipt of a 'Completed' report.

Completed reports indicate that the fulfiller has completed all the items in the report and does not expect to send any further update to the report. This does NOT mean that a further report will not follow and in some circumstances, further updates may be sent by the fulfiller when additional information comes to light.

The Coded Simple datatype is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary and is constrained in this release to 'Active', 'Completed' or, in the case of a Nullified interaction, 'Nullified'.

The effective date carries the clinically significant time for the report. This is generally the collection time of the specimen on which the work was performed. In certain types of report, there is more than one specimen on which the report is based. In such circumstances, the effective time of the report is the most clinically significant time. In a Dynamic function test, this would be the start time of the test. In a Multi-sample microbiological screen, all specimens will have been collected at approximately the same time and the time of the first serves as the clinically significant time for the screen.

For a Creatinine Clearance request, the effective time would be the start collection time of the Urine specimen. 

See also the author.time field.

Identifies the priority of the report as determined by the reporting department. Value is constrained to be 'Routine' or 'Urgent'.

Refers to the patient who is the subject of the laboratory report.

The Performer of the Observations and report. Generally the performing department.

Refers to the person or department responsible for authorising the  laboratory report. In most cases, this will be the department in which the work was performed. In some instances, e.g. Histopathology reports, there may be a requirement to identify the actual person authoring the report.

Refers to the person or department who is the primary business recipient of the laboratory report. This is generally the Health Care Professional responsible for the patient at the time of the encounter that gave rise to the request.

Identifies the specimen/isolate which was the subject of the investigation(s)

Refers to people or departments who are identified as copy recipients of the laboratory report .

There can be zero, one or many copy recipients.

Provides structure to the report, allowing different levels of detail.

Provides the link between the request and the fulfilling results.

Reason for the request

Details about the patient.

Indicates that the role is that of a patient.

• Fixed value: "PAT"

The NHS number that identifies the patient.

An Instance Identifier (Identifier External flavour) representing the NHS number that identifies the patient.

• The root attribute shall contain the OID for NHS Number
• The extension attribute contains the 10 digit NHS Number

Information about the person who is the identified patient.

Organisation or person

NPfIT CMET to identify an organization associated with the Report. Full details of the organization are available from SDS. Details of the scoping organization are either not required or available from SDS.

This CMET should only be used if an individual health care professional is not available.

Only the following Classes and Attributes from this CMET shall be included in this message.  Classes and attributes that are not detailed below are not to be used in this message.

AgentOrgSDS.id - shall carry a nationally agreed identifier for the role being played.  This shall be a code from a national coding scheme.

A national code is carried in the following way:

• The root attribute shall contain the OID that identifies the coding scheme.
• The extension attribute shall contain the code.

AgentOrgSDS.code - shall carry a code from the HL7 vocabulary RoleCode to identify the type of role that the agent is playing.

OrganizationSDS.id - shall carry a valid SDS identifier that uniquely identifies the Organization.   This could come from a number of SDS sets including (but not limited to) Organizations and Workgroups:

• The root attribute shall be the OID for the SDS code set
• The extension attribute shall contain the code.

NPfIT CMET to identify a person associated with the Report. Full details of the person and role profile are available from SDS.

This CMET should be used in preference to UKCT_MT120501UK03.

Only the following Classes and Attributes from this CMET shall be included in this message.  Classes and attributes that are not detailed below are not to be used in this message.

AgentPersonSDS.id shall  carry An SDS identifier that uniquely identifies the role of the Person in the following way:

• The root attribute shall contain an OID with the value 1.2.826.0.1285.0.2.0.67.
• The extension attribute shall contain the SDS Role Profile ID.

PersonSDS.id shall carry an SDS identifier that uniquely identifies the Person in the following way:

• The root attribute shall contain an OID with the value 1.2.826.0.1285.0.2.0.65.
• The extension attribute shall contain the SDS User ID.

The ObservationEventChoice allows for the messaging of reported events in a defined structure. The level of recursion is limited by the constraints on the Component recursion.

This recursion allows for one choice to have other acts from the choice as component acts. This is subject to the following constraint:-

If

source is ObservationReport; then target may be any choice

else if

source is ObservationBattery; then Target must be ObservationEvent

else if

source is SpecimenObservationCluster; then target must be   ObservationBattery or ObservationEvent

else if

source is ObservationEvent; then target must be ObservationEvent.

Conveys relevant clinical information.

Provides the mechanism for the linking of a performed (Fulfiller) act to the request (Placer) act that is being fulfilled.

These are different acts and may be different SnCT concepts. A single Fulfilling act may fulfill one or more Placer request acts or multiple Fulfilling acts may be performed in fulfillment of a single Placer request act.

Refers to a previous act that this act is intended to replace. Replacement is used where the replacing act has a different Act.code but is of the same act type. In normal update circumstances no replacementOf is needed, the same act is messaged with the same id and updated fields. The interaction will identify to the receiving system intent of the message.

Identifies the reason (generally clinical) for the request. This is usually provided by the placer of the request. 

A set of related observations performed on a single specimen

An individual observation

A sub-report within the overall Laboratory Report

A group of observations or batteries of observations performed on an single Identified Isolate.

This is only used where a report is being withdrawan and replaced with a different report, not an updated report. Normal Update interaction is used with the same report ID & new interaction ID

Fixed at 'ENTRY'

Fixed at 'EVN'

The ID of the Prior report that is being replaced. The new report is a 'different' report not an update to the original.

Shall be set to 'Obsolete'

Demographic details of the patient

Indicates that the entity is a person.

• Fixed value: "PSN"

Indicates that the entity is a single identifiable person.

• Fixed value: "INSTANCE"

To provide zero or more structured names of the patient.

Zero or one occurrence of the usual name may be provided.

Zero or more occurrences of alias names may also be provided.

Zero or one occurrence of a preferred name may also be provided.

The following sub-elements are used to carry components of a structured name:

• A single instance of the prefix element is used to carry a name title, for example, Mr, Mrs, Ms etc;
• One or more instances of the given element are used to carry given names (or forenames) or initials, with the order in which they are carried in the message being significant, i.e. the first occurrence of the given element is used to carry the first given name, the second occurrence of the given element is used to carry the second given name etc;
• A single instance of the family element is used to carry the family name (or surname);
• A single instance of the suffix element is used to carry a name prefix, for example, Jnr, Snr etc.

Where the usual name is being carried, this is required to be indicated with a value of "L" in the use attribute.

Where an alias name is being carried, this is required to be indicated with a value of "A" in the use attribute.

Where a preferred name is being carried, this is required to be indicated with a value of "PREFERRED" in the use attribute.

For the usual name type, the validTime sub-element may be used to indicate dates from and to which the name was/is to be effective, in the following way:

• The low sub-element of the validTime element may optionally be present with the date from which the name was effective provided in YYYYMMDD format in the value attribute;
• The high sub-element of the validTime element may optionally be present with the date to which the name was/is to be effective provided in YYYYMMDD format in the value attribute.

To provide the current registered sex of the patient in coded form.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Sex vocabulary;

To provide the date the patient was born.

The date may be given in one of the following formats:

• YYYYMMDD where the full date of birth is known;
• YYYYMM or YYYY where the full date of birth is not known.

One of the Date Only or Date Month or Date Year datatype flavours is used to carry this information as follows:

• The value attribute will contain the date value in one of the formats indicated.

Carries the patient's home address.

An address is composed of the following components:

• Between one and five unstructured address lines;
• Postcode;

Other optional parts of AD datatypes are not required (eg. use, addressKey and usablePeriod).

• An effective from date may be provided for every address; an effective to date may also be provided for any address.

The first of these components is required to be present with any address.

The following sub-elements are used to carry the components of an address:

• Between one and five streetAddressLine elements are used to carry unstructured address lines, with the order in which they are carried in the message being significant, i.e. the first occurrence of the streetAddressLine element is used to carry the first line of address, the second occurrence of the streetAddressLine element is used to carry the second line of address etc;
• A postalCode element is used to carry a postcode;

The clinically significant Ethnicity of the patient. This is important in the interpretation of some results and may have reference ranges based upon it. It is not the ethnicity by which the patient chooses to be identified but the genetically significant parentage.

A group of related observations carried out on a single Specimen/Isolate.

Indicates that this is a battery of investigations

• Fixed value: "BATTERY"

Indicates that this is an event.

• Fixed value: "EVN"

A list of  identifiers for this observation battery.

The first (mandatory) identifier is a local identifier allocated by the originating system. It is made up of two parts, a root and extension. The Root will be an OID allocated to the system that generates the extension and will be at such a level that the combination of the Root and Extension is universally unique. The extension will be a human readable string generated by the system and may not be unique across the whole system.

E.g. There are many systems that are configured on a departmental basis and the same range of human readable strings are used in multiple departments. In such cases, the Root OID shall be allocated at such a level that the human readable portion is unique within that Root OID.

< id root =" 9.99.999.99.10.2 " extension ="0001192992 "/>

Where 9.99.999.99.  identifies the Hospital organization and 9.99.999.99.10.2 identifies the ID scheme within the Laboratory system that generated the extension.

As well as conveying a real world business identifier that the observation battery may have, the presence of an id allows this act to be "replaced" in a future message should that be necessary (see replacementOf).

The second id is for possible future use ("snapshot" id).

This is used to carry the code value for any battery of tests (FBC, U&E, etc) carried out in fulfillment of part or all of a request act. This is a required attribute and shall be populated with a concept ID from the national subset of Investigations (SNOMED Lab Investigations Subset_UK_20060401) that are defined as 'Batteries'.

The status of a reported act may be 'Active', 'Completed', 'Aborted' or, when sent as part of a Nullify interaction, it shall be 'Nullified'.

If a Battery is replaced, the status of the replaced battery shall be 'Obsolete'.

'Active' batteries are those for which all components are not 'Completed' or 'Aborted'. 'Completed' batteries shall have all components either 'Completed' or 'Aborted'.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary and is constrained in this release to 'Active', 'Completed', 'Aborted' or, in the case of a Nullified interaction, 'Nullified'.

Identifies the clinically significant time of the battery. This will generally be the time at which the specimen on which the battery component acts where preformed.

Identifies the priority of the act by the Fulfiller. This may highlight urgent results to the Placer

The specimen.

An individual observation performed by the Fulfiller. This may be a component part of an Entry, Cluster or Battery. Observations are the only Act class that may carry a 'Value'. The Observation may also carry 'Laboratory Clinical Comments' at all report levels

Indicates that this is an observation.

• Fixed value: "OBS"

Indicates that this is an event.

• Fixed value: "EVN"

A list of  identifiers for this observation.

The first (mandatory) identifier is a local identifier allocated by the originating system. It is made up of two parts, a root and extension. The Root will be an OID allocated to the system that generates the extension and will be at such a level that the combination of the Root and Extension is universally unique. The extension will be a human readable string generated by the system and may not be unique across the whole system.

E.g. There are many systems that are configured on a departmental basis and the same range of human readable strings are used in multiple departments. In such cases, the Root OID shall be allocated at such a level that the human readable portion is unique within that Root OID.

< id root =" 9.99.999.99.10.2 " extension ="0001192992 "/>

Where 9.99.999.99.  identifies the Hospital organization and 9.99.999.99.10.2 identifies the ID scheme within the Laboratory system that generated the extension.

As well as conveying a real world business identifier that the observation may have, the presence of an id allows this act to be "replaced" in a future message should that be necessary (see replacementOf).

The second id is for possible future use ("snapshot" id).

This is used to carry the code value for any single observation (Sodium measurement, Haemoglobin,White cell count, Cervical smear etc) carried out in fulfillment of part or all of a request act. Where it is a component of a Battery, the Battery may be the fulfilling act. This is a required attribute and shall be populated with a concept ID from the national subset of Investigations (SNOMED Lab Investigations Subset_UK_20060401).

This may be post-coordinated by an Investigation Method from SNOMED lab investigation method subset_UK_20060401 and/or a Component (Substance) taken from the appropriate National Snomed CT Subset.

E.g. Susceptability Test <has method> Disk Diffusion <has component> Ampicillin.

NOTE: See current issues in Implementation Manual.

(The interpretation result of the susceptibility test shall always be carried in 'InterpretationCode' (S/R/I) and any measurement such as a zone size in 'Value').

In most cases in the Laboratory report this will be part of a Code - Value pair where the code identifies the observation and Value carries the result of that observation. This is clearly true for measurements with numerical results which cannot be post-coordinated in Snomed but, where the result is coded, it may be carried as a pre or Post coordinated term or a qualifier value carried in 'Value'.  Concepts from the Snomed 'Clinical Findings' hirearchy shall not have 'Values'.

Work is currently underway in the HL7 Terminfo group and in Snomed to define exact use of Snomed within HL7 v3

For Laboratory Clinical Comments, the SnCT Concept "Laboratory Clinical Comment" (ID TBA) is used in the Act.code and the comment as Text in the Value. The nature of the recursion allows for Observations to be components of all levels within the message so comments may be components of Reports, Batteries or other observations.

The status of a reported act may be 'Active', 'Completed', 'Aborted' or, when sent as part of a Nullify interaction, it shall be 'Nullified'.

'Active' Observations are those for which the result is 'interim' and will be finalised at a later time.

Where an observation act is replaced by a new observation act (different Act.code), the status of the replaced observation shall be set to 'Obsolete'.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary and is constrained in this release to 'Active', 'Completed','Aborted' or, in the case of a Nullified interaction, 'Nullified'.

Identifies the clinically significant time of the Observation. This will generally be the time at which the specimen on which the observation was preformed was collected.

Identifies the priority of the act by the fulfiller. This may highlight urgent results to the Placer. Valid contents are 'Routine' or 'Urgent' only

The value may be Numeric, Coded (SnCT), Time or Text.

One or more codes specifying a rough qualitative interpretation of the observation such as "High", "Low", "Outside Range", "Significant Change", "Resistant", "Susceptible", etc.

Use is restricted to the ObservationInterpretation SnCT Vocabulary and may contain a value from both ObsInterpretationChange Subset:(Significant Change, Highly Significant Change) and ObsInterpretationNormality subsets (High, Low, Outside Range), at the same time. This allows for a result to be interpreted as both High/Low values with respect to the used Range and RCV Significant Change etc.

The type of range is carried in the Criterion (see below)

In most instances where a value is carried in the interpretationCode, there will also be a value in observation.value and an associated  interpretationRange.

However, in the reporting of Microbiological Susceptibility test interpretations ObsInterpretationSusceptibility subset (Resistant, Susceptible, Intermediate)  there will often not be a value. Where Susceptibility interpretation is reported with a value (MIC, MBC, zone size etc) the value shall carry the actual value of the result; and the interpretationCode the interpretation of Susceptible, Intermediate or Resistant.

The specimen.

The derivedFrom relationship provides a mechnanism for the handling of Calculated results. Where the value of act 'A' is calculated from acts 'B' and 'C', those acts may be associated with act 'A' using a derivedFrom relationship where it is semantically important to convey this relationship. 

Provides for the carrying of ranges upon which any interpretation of the result in the source act are based. Typically used for 'Reference Ranges' or 'Normal Population Ranges'. These are generally only used for Numerical results.

This is only used in those circumstances where a Laboratory Report contains sub-reports carried out on different specimens and each consists of multiple components (Batteries/Observations).

Indicates that this is an entry.

• Fixed value: "ENTRY"

Indicates that this is an event.

• Fixed value: "EVN"

A list of  identifiers for this observation report.

The first (mandatory) identifier is a local identifier allocated by the originating system. It is made up of two parts, a root and extension. The Root will be an OID allocated to the system that generates the extension and will be at such a level that the combination of the Root and Extension is universally unique. The extension will be a human readable string generated by the system and may not be unique across the whole system.

E.g. There are many systems that are configured on a departmental basis and the same range of human readable strings are used in multiple departments. In such cases, the Root OID shall be allocated at such a level that the human readable portion is unique within that Root OID.

< id root =" 9.99.999.99.10.2 " extension ="0001192992 "/>

Where 9.99.999.99.  identifies the Hospital organization and 9.99.999.99.10.2 identifies the ID scheme within the Laboratory system that generated the extension.

As well as conveying a real world business identifier that the observation may have, the presence of an id allows this act to be "replaced" in a future message should that be necessary (see replacementOf).

The second id is for possible future use ("snapshot" id).

Similar to the Laboratory report, this shall carry the code Laboratory Report unless one of the special types (DFT, screen etc.) and shall be taken from  SNOMED lab investigation subset_UK_20060401.

Identifies if the report is 'Active', 'Completed' or, in a Nullify interaction, 'Nullified'.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary and is constrained in this release to 'Active', 'Completed' or, in the case of a Nullified interaction, 'Nullified'.

This is the clinically significant time of the sub-report. It is generally the collection time of the specimen in the report.

Fulfillers priority of the report. Routine or Urgent.

The specimen.

Specifically for the reporting of observations performed on a single, identified isolate. The SpecimenObservationCluster has a fixed SnCT Act.code

Indicates that this is a cluster.

• Fixed value: "CLUSTER"

Indicates that this is an event.

• Fixed value: "EVN"

This is fixed as 197421000000107 - Isolate identified (Finding). The associated Entity carries the identity of the isolate and the Role the ID

May be Active, Completed, Aborted, Nullified. 

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary and is constrained in this release to 'Active', 'Completed' or, in the case of a Nullified interaction, 'Nullified'.

Clinically significant time for the specimen in which the isolate was detected. (Specimen Collection Time) 

The specimen.

SupportingClinicalInformationChoice provides for the carriage of any clinical information in support of the request. This may be an observation, medical procedure, a clinical condition, substance administration etc. 

The Placer Order is the Act(s) being fulfilled by the Fulfiller Act.

Each Requested act shall be fulfilled by the fulfiller. The Laboratory Report may fulfill, partially or completely one or more Placer Orders. Observations Events or Observation Batteries may fulfill, partially or fully, one or more Observation Requests

Indicates that this is an act. The value should correspond to that of the Act being fulfilled ie. ACT (in the case of 'group' requests) or OBS.

Indicates that this is a request.

• Fixed value: "RQO"

The placer allocated "local" identifier of the Placer Request.being fulfilled

The act being replaced.

Indicates that this is an entry.

• Fixed value: "ENTRY"

Indicates that this is an event.

• Fixed value: "EVN"

This carries the identifier of the report that is being replaced. It corresponds to the locally allocated id from the earlier report's LaboratoryReport Act.

The Coded Simple datatype is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary and is constrained in this case to 'Obsolete'.

SupportingClinicalInformationChoice provides for the carriage of any clinical information in support of the request. This may be an observation, medical procedure, a clinical condition, substance administration etc. 

This Act carries the Interpretation Range against which the source act was/may be interpreted. This is generally a Reference Range but may also be a Reference Change Value (RCV). Both may be carried in the same message for each appropriate observation Event.

Indicates that this is an observation.

• Fixed value: "OBS"

Indicates that this is an event criterion.

• Fixed value: "EVN.CRT"

Carries the actual value(s) of the Interpretation range that have been used for interpretation of the Observation Event value in the source act. It should be noted that a value does not have to be present in the Source act in order to provide an interpretation of Susceptibility.

EITHER:-

The Value shall be a numerical (interval) which may have a Low and High, a Low or a High value.

Generally, interpretation ranges are nn.nn - nn.nn but in some instances, there may only be a High value( < nn.nn) or a Low value (> nn.nn)

OR:-

The Value may be a Reference Change Value (RCV) 95% probability or RCV 99% probability value as an absolute, real number with associated units or a percentage. 

Default to  'N'. Indicates that this is a 'Normal' type value range (not a normal value)

Links the Interpretation Range to the Criterion on which that range is based.

A Criterion is a constraint on the source act. The source act is subject to the constraint. The constraint for an Interpretation Range may be a Sex or Age parameter etc.

Indicates that this is an observation.

• Fixed value: "OBS"

Indicates that this is an event criterion.

• Fixed value: "EVN.CRT"

Indicates the type of  Interpretation Range. This is currently limited to:-

220221000000104 | Range criteria (qualifier value)

Additional information on the Type of range shall be carried in Criterion.text as a text string.

E.g. Normal Population Reference Range, Sex based Range etc.

Or for Reference Change Value reporting:-

220231000000102 | Reference change value 95% probability of significance (qualifier value)

220241000000106 | Reference change value 99% probability of significance (qualifier value)

Carries a text description of the Range Criteria when RangeCriteriaSnCT has a value of  220221000000104 | Range criteria (qualifier value)

This may be Population Based, Age related, Sex related, Ethnicity related etc or be more explicit such as Normal Range for 1 - 4 yr olds etc.

The Criterion does NOT carry the actual range itself. This is carried in the 'Value' of the Interpretation Range

In future this may be used to carry the value of the criterion. For a Sex related criterion, this may be Male, Female; for an Age related criterion, this may be an Age interval 1y - 12y or < 19y etc.