This wiki has undergone a migration to Confluence found Here

Difference between revisions of "Laboratory Results"

From HL7 Argonaut Project Wiki
Jump to navigation Jump to search
Line 49: Line 49:
 
* a LOINC code which tells you what is being measured
 
* a LOINC code which tells you what is being measured
 
** note: additional codes that translate or map to these are allowed - e.g. method specific LOINC Codes, SNOMED CT concepts, system specific codes
 
** note: additional codes that translate or map to these are allowed - e.g. method specific LOINC Codes, SNOMED CT concepts, system specific codes
* a result value (1) and if the result value is a numeric quantity, a standard UCUM unit
+
* a result value and if the result value is a numeric quantity, a standard UCUM unit
** note: if there is no result then you have to supply a reason
+
** note: if there is no result then you have to supply a reason unless Observation is being used to group a panel then there is no value.  Instead, it just includes composite values or related links
 
* a status
 
* a status
 
* a category code of 'laboratory'
 
* a category code of 'laboratory'
Line 57: Line 57:
 
* a time indicating when the measurement was taken
 
* a time indicating when the measurement was taken
 
* a reference range if available
 
* a reference range if available
 
(1) note: If Observation is being used to group a panel then there is no value.  Instead, it just includes composite values or related links
 
  
 
===Laboratory Results Table===
 
===Laboratory Results Table===

Revision as of 19:49, 31 March 2016

Back to Argonaut Implementation Guide

Introduction

The Argonaut Laboratory Results guide provides the API documentation for searching and fetching Laboratory Results. It is based on the Data Access Framework (DAF) Laboratory Results and draws requirements from Argonaut Sprint 6. The search criteria provided in the Quick Start are intended to support the 2015 Edition ONC Certification criterion Data Category Request 170.315(g)(8).

Argonaut Success Criteria

Clients

  • A client has connected to a server and fetched all of a patient's laboratory diagnostic reports using GET [base]/DiagnosticReport?patient=[id]&category=LAB.
  • A client has connected to a server and fetched all of a patient's laboratory results listed in the table below using GET [base]/Observation?patient=[id]&category=laboratory.

Servers

  • A server is capable of returning all of a patient's laboratory diagnostic reports using GET [base]/DiagnosticReport?patient=[id].
  • A server is capable of returning all of a patient's laboratory results using GET [base]/Observation?patient=[id].
  • A server has ensured that every API request includes a valid Authorization token, supplied via:Authorization: Bearer {server-specific-token-here}
  • A server has rejected any unauthorized requests by returning an HTTP 401 Unauthorized response code.

Mandatory Data Elements

The following data-elements in the Observation resource are mandatory (i.e data MUST be present). These are presented below in simple human-readable explanation and a more thorough summary of the requirements. Refer to the table for additional quidance and examples for the various laboratory tests.

Each DiagnosticReport must have:

(big issue is do we support both DR and Obs do we create separate IGs)

  • a patient
  • a code (preferably a LOINC code) which tells you what is being measured
    • note: additional codes that translate or map to these are allowed - e.g. method specific LOINC Codes, SNOMED CT concepts, system specific codes
  • at least one result (an Observation reference)
    • note: if there is no numeric result then you have to supply a reason
  • a status
  • a category code of 'LAB'
    • note: additional category codes that translate or map to these are allowed - e.g. more specific category codes such as "CH" (chemistry), SNOMED CT concepts, system specific codes
  • a time indicating when the measurement was taken
  • a time indicating when the measurement was reported
  • who issues the report


Each Observation must have:

  • a patient
  • a LOINC code which tells you what is being measured
    • note: additional codes that translate or map to these are allowed - e.g. method specific LOINC Codes, SNOMED CT concepts, system specific codes
  • a result value and if the result value is a numeric quantity, a standard UCUM unit
    • note: if there is no result then you have to supply a reason unless Observation is being used to group a panel then there is no value. Instead, it just includes composite values or related links
  • a status
  • a category code of 'laboratory'
    • note: additional category codes that translate or map to these are allowed - e.g. more specific category codes such as "chemistry', SNOMED CT concepts, system specific codes

Each Observation should have:

  • a time indicating when the measurement was taken
  • a reference range if available

Laboratory Results Table

The attached table is derived from the LOINC Top 2000+ Lab Observations and lists the LOINC observation code, and corresponding UCUM units of measure codes for qualitative tests. This Argonaut profile does not make the presence or absence of any of these mandatory and is provided for guidance only.

LOINC TOP 2000 (CLICK on the title for the complete listings)

Rank LOINC # Long Common Name UCUM Comment Example
1 2160-0 Creatinine [Mass/volume] in Serum or Plasma mg/dL Example
2 718-7 Hemoglobin [Mass/volume] in Blood g/dL This is the the code included in the CBC auto. It is NOT obtained via the automated counting but uses a chemistry method just like most other hemoglobins Example
3 2823-3 Potassium [Moles/volume] in Serum or Plasma mmol/L Example
4 2345-7 Glucose [Mass/volume] in Serum or Plasma mg/dL Example
5 2951-2 Sodium [Moles/volume] in Serum or Plasma mmol/L Example
6 3094-0 Urea nitrogen [Mass/volume] in Serum or Plasma mg/dL Usually called BUN Example
7 2028-9 Carbon dioxide, total [Moles/volume] in Serum or Plasma mmol/L Example
8 2075-0 Chloride [Moles/volume] in Serum or Plasma mmol/L Example
9 789-8 Erythrocytes [#/volume] in Blood by Automated count 10*6/uL Example
10 786-4 Erythrocyte mean corpuscular hemoglobin concentration [Mass/volume] by Automated count g/dL Example
11 785-6 Erythrocyte mean corpuscular hemoglobin [Entitic mass] by Automated count pg Example
12 17861-6 Calcium [Mass/volume] in Serum or Plasma mg/dL Example
13 2339-0 Glucose [Mass/volume] in Blood mg/dL Example
14 4544-3 Hematocrit [Volume Fraction] of Blood by Automated count % Most Hematocrits delivered by referral and hospital laboratories will be produced by automated count- and will be delivered with this code Example
15 6690-2 Leukocytes[#/volume] in Blood by Automated count 10*3/uL Example
16 1742-6 Alanine aminotransferase [Enzymatic activity/volume] in Serum or Plasma U/L Example
17 787-2 Erythrocyte mean corpuscular volume [Entitic volume] by Automated count fL 99% of these values will be done by automated method Example
18 777-3 Platelets [#/volume] in Blood by Automated count 10*3/uL 99% of all blood count will be automated so this is usually the right choice Example
19 1920-8 Aspartate aminotransferase [Enzymatic activity/volume] in Serum or Plasma U/L Example
20 1751-7 Albumin [Mass/volume] in Serum or Plasma g/dL Example
21 1975-2 Bilirubin.total [Mass/volume] in Serum or Plasma mg/dL Total bilirubin = direct + indirect. Example
22 2885-2 Protein [Mass/volume] in Serum or Plasma g/dL Example
23 6768-6 Alkaline phosphatase [Enzymatic activity/volume] in Serum or Plasma U/L Example
24 788-0 Erythrocyte distribution width [Ratio] by Automated count % This it the version of the RDW reported with units of % Do not confuse with the term that reports the same test name with units of fL (LOINC 21000-5) Example
25 770-8 Neutrophils/100 leukocytes in Blood by Automated count % This cell type is counted by all modern automated differential machines; so most results will be reported under the LOINC code with method of automated count. Example
... ... ... ... ... ...

Complete Summary of the Mandatory Requirements

todo

Quick Start

Below is a quick overview of the required search and read operations

GET [base]/DiagnosticReport?patient=[id]&category=LAB

Support: Mandatory to support search by category code = LAB.

Implementation Notes: Search based on diagnostic report category code = 'LAB'. This fetches a bundle of all lab related DiagnosticReports resources for the specified patient (how to search by reference) and (how to search by token).

Response Class:

  • (Status 200): successful operation
  • (Status 400): invalid parameter
  • (Status 401/4xx): unauthorized request
  • (Status 403): insufficient scope

Example:

[GET http://spark.furore.com/fhir/DiagnosticReport?patient=f201&category=LAB]

GET [base]/Observation?patient=[id]&category=laboratory

Support: Mandatory to support search by category code = laboratory

Implementation Notes: Search based on laboratory category code = "laboratory". This fetches a bundle of all Observation resources with laboratory categories for the specified patient (how to search by reference) and (how to search by token).

Response Class:

  • (Status 200): successful operation
  • (Status 400): invalid parameter
  • (Status 401/4xx): unauthorized request
  • (Status 403): insufficient scope

Example:

[GET https://fhir-open-api-dstu2.smarthealthit.org/Observation?patient=1134281&category=laboratory]

GET [base]/DiagnosticReport?patient=[id]&code=[Laboratory order LOINC]

Support: SHOULD support search DiagnosticReport by laboratory order codes

Implementation Notes: Search based on Diagnostic report code. This fetches a bundle of all DiagnosticReport resources for a specific diagnostic order code for the specified patient (how to search by reference) and (how to search by token).

Response Class:

  • (Status 200): successful operation
  • (Status 400): invalid parameter
  • (Status 401/4xx): unauthorized request
  • (Status 403): insufficient scope

Example:)

Search for all heart rate observations for a patient:
[GET https://fhir-open-api-dstu2.smarthealthit.org/DiagnosticOrder?patient=1186747&code=8867-4] 

GET [base]/Observation?patient=[id]&code=[Laboratory order LOINC]

Support: SHOULD support search Observation by laboratory LOINCs.

Implementation Notes: Search based on laboratory LOINC code. This fetches a bundle of all DiagnosticReport resources for a specific observation LOINC code for the specified patient (how to search by reference) and (how to search by token).

Response Class:

  • (Status 200): successful operation
  • (Status 400): invalid parameter
  • (Status 401/4xx): unauthorized request
  • (Status 403): insufficient scope

Example:)

Search for all heart rate observations for a patient:
[GET https://fhir-open-api-dstu2.smarthealthit.org/Observation?patient=1186747&code=8867-4]

GET [base]/Observation?patient=[id]&code=[lab1 LOINC, lab2 LOINC, etc]

(TODO_repeat for DR)

Support: SHOULD support Observation search by multiple LOINCs. .

Implementation Notes: Search based on multiple laboratory LOINC codes. This fetches a bundle of all Observation resources for specific laboratory results listed in the table above for the specified patient (how to search by reference) and (how to search by token) and (how to search for multiple values)

Response Class:

  • (Status 200): successful operation
  • (Status 400): invalid parameter
  • (Status 401/4xx): unauthorized request
  • (Status 403): insufficient scope

Example:

Search for all heart rate, respiratory rate and blood pressure observations for a patient
[GET https://fhir-open-api-dstu2.smarthealthit.org/Observation?patient=1186747&code=8867-4,9279-1,55284-4]

GET [base]/Observation?patient=[id]&category=laboratory=[eq|lt|gt|geyyyy-mm-dd]

(repeat for DR)

Support: SHOULD support search by category code and date

Implementation Notes: Search based on laboratory category code and date. This fetches a bundle of all Observation resources with category 'vital-signs' for the specified patient for a specified time period (how to search by reference)and (how to search by token) and (how to search by date).

Response Class:

  • (Status 200): successful operation
  • (Status 400): invalid parameter
  • (Status 401/4xx): unauthorized request
  • (Status 403): insufficient scope

Example:

Find all the laboratory results after 2013-03-14
[GET http://fhir2.healthintersections.com.au/open/Observation?patient=555580&category=laboratory&date=ge2015-01-14]

Open Issues

The following issues have been identified:

  1. What is a consistent pattern for grouping Observations into panels?
    • Whether to use DiagnosticReport and Observation or just Observation or both
  2. Should scope success criteria should be just fetching all labs or also fetching specific labs based on codes as well?
  3. Are there other way to select only labs vs other observations rather than the suggested approach proposed above?
  4. (several of the same issues as in Vitals)
  5. Should a DiagnosticOrder reference be mandatory element for DiagnosticReport as it is in the DAF profile?


Resources

Formalized testing with test scripts and objective results reporting is available through the participation of AEGIS and MITRE (Crucible). The testscript provided can be used to test servers: [todo]

References



Back to Argonaut Implementation Guide