Status: Active: Approved (STU)

Introduction

This profile sets minimum expectations for the Diagnostic Report resource. As noted in the FHIR specifications, a Diagnostic Report allows for presenting a combination of:

• A written report “document”
• Structured results in the form of Observations
• Imaging (although this is currently out of scope for the shared care record)

Mandatory fields

The following mandatory fields are defined for a Diagnostic Report:

1. Status - this is mandatory in FHIR, with a short list of codes provided. Most commonly the status will be “final”. (Other statuses may be used if relevant, but must be kept up-to-date)

2. Subject - every Diagnostic Report must be linked to a Patient

3. Issued date - when the report was issued

4. Category - provides a high-level categorisation of the report. This is based on a short and simple list provided by FHIR which is expected to be straightforward to map to (eg “Radiology”). Useful for sorting and filtering.

5. Code - this is mandatory in FHIR and defines in more detail the type of diagnostic report. The coding of diagnostic reports is known to be a difficult topic, and at this stage a single set of codes is difficult to prescribe. However the following are preferred, most favoured first:

   • SNOMED - CareConnect defines the use of SNOMED coding based on the use of 371525003 - Clinical procedure report

   • NICIP - this code list covers only imaging. However within that domain it has been defined by NHS Digital and mandated for use by the Information Standards Board. See https://digital.nhs.uk/services/terminology-and-classifications/national-interim-clinical-imaging-procedure-nicip-code-set. Note that the NICIP codes include a maintained standard mapping to SNOMED, and so typically the associated SNOMED code can also be provided as a second coding

   • LOINC - the default mapping in FHIR is to LOINC codes for diagnostic reporting

   • Local Codes - outside of the imaging domain there is significant variation in coding and, whilst mapping to one of the above standards is preferred, it may not always be feasible.

   NB: Any intention to use local codes must be explicitly discussed and approved

   NB: In all cases display text must be provided so that, regardless of coding, the type of report can be understood by a user

Must Support fields

In addition the following fields are “Must Support” - ie they must be populated if relevant and known:

1. Identifier - a Local Id should be provided, such that could be quoted if manually getting in touch to find out more

2. Effective date - important date to provide details of the clinically relevant period, where relevant (eg based on when specimens taken - see FHIR guidance notes for further details)

3. Context - this provides a link to the Encounter. Whilst there will not always be an Encounter, it is important to populate if it is relevant - to help build the complete picture by linking together all activities surrounding the Encounter

4. Presented Form - this allows for a textual report to be offered. This must be provided whenever a written report “document” is present.

   • Within “presented form” it is mandatory to populate the Content Type, so that consumers can be aware and process accordingly.

     Data Providers and Data Consumers SHOULD support the following contentTypes:

     • application/pdf
     • text/html
     • image/tiff (no longer supported and is not recommended for web use)
     • image/jpeg
     • image/png (currently not supported in Interweave Portal, however it is on the roadmap)

     (This list may be added to by request and discussion)

     Other contentTypes should only be used with caution, as not all Data Consumers may be able to view them.

   • As of this writing (Feb 2022) the actual content must be Base64 encoded and included in the “data” element
   • Longer term it is anticipated that the messaging infrastructure will be enhanced to also support “url” links to a separately saved document - with this then becoming the preferred mechanism due to the reduced message size. (See DocumentReference for further guidance on providing url links)
   • A particular issue for Diagnostic Reports is that the underlying source for many diagnostic reports is messages extracted from a text-based lab or RIS system.
     • The strongly preferred approach is to reformat textual reports as HTML - as this is an interoperable standard which guarantees consistent presentation across any consumer system
     • It is also important to ensure that any such text is HTML Encoded - for example to make sure that characters such as “<” in the report do not cause problems when displaying.
     • In some cases this presentation as HTML may be relatively easy to do - for example if the report is already structured as separate lines which can be simply “decorated” with HTML tags
     • In other cases it may be much more difficult to format the report text - for example if the original report is structured as a single block of text containing various escape characters. Tackling this is, however, a key part of a Data Provider’s work in offering their reports in an interoperable format for wider sharing.

5. Result - this allows for (semi) structured results to be offered in the form of a list of Observations. Whilst some types of Diagnostic Report are purely textual, for others these structured Observations are extremely important.

   Note: The relevant Observations for different types of report, and tips for populating from common Radiology and Lab systems is potentially a topic for a further paper in its own right

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Points of note include:

• Conclusion - this is an important field, and only considered “optional” due to the potential difficulty of populating it in practice. It provides a brief summary of the findings, typically easier to understand than the technical detail of the full report. This information can often be found in the “comments” field(s) of a lab or RIS system. However the wide variation in usage of these “comments” fields can make it challenging to identify and extract reliably.

• Coded Diagnosis - this is in effect the “conclusion” in coded form (In FHIR R4 this field is renamed as “conclusionCode”). Whilst this could obviously be useful to populate, it often may not be feasible given the challenges described above in extracting even a text-based conclusion

• Specimen - if relevant and available then details of the specimen should be provided

• Performer - again this may be useful if available. (Noting that for a regional shared care record the practitioner managing the overall encounter may often be of greater relevance).

Discouraged or Removed fields

• Image and Imaging Study - the priority for the shared care record is to share results and reports, rather than raw image data. As of this writing (Feb 2022) there is no support for retrieving these imaging links. (Note that this position could change in future - please get in touch if you have a specific use-case)

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from CareConnect-DiagnosticReport-1

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	CareConnect-DiagnosticReport-1	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	S	0..1	id	Logical id of this artifact
meta
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for identifier		0..*	Identifier	Business identifier for report Slice: Unordered, Open by value:system
identifier:localIdentifier	S	0..1	Identifier	Business identifier for report
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-diagnostic-report-identifier
value	S	1..1	string	The Local diagnostic-report Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
status	S	1..1	code	registered | partial | preliminary | final +
category	S	1..1	CodeableConcept	Service category Binding: Diagnostic Service Section Codes (required)
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
code	S	1..1	CodeableConcept	Name/Code for this diagnostic report Binding: Care Connect Report Code SnCT (preferred)
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:nicip		0..1	Coding	Code defined by a terminology system
system	S	0..1	uri	Identity of the terminology system Fixed Value: https://fhir.yhcr.nhs.uk/CodeSystem/Interweave-NICIP-1
code	S	0..1	code	National Interim Clinical Imaging Procedure code Binding: InterweaveNICIP codes (required)
display	S	0..1	string	Representation defined by the system
coding:loinc		0..1	Coding	Code defined by a terminology system
system	S	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	S	0..1	code	LOINC code Binding: LOINC Diagnostic Report Codes (required)
display	S	0..1	string	Representation defined by the system
subject	S	1..1	Reference(CareConnectPatient1)	The subject of the report - for our purposes the patient
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
context	S	0..1	Reference(CareConnect-Encounter-1)	Health care event when test ordered
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
effective[x]	S	0..1	dateTime, Period	Clinically relevant time/time-period for report
issued	S	1..1	instant	DateTime this version was released
result	S	0..*	Reference(CareConnect-Observation-1)	Observations - simple, or complex nested groups
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
imagingStudy		0..*	Reference(ImagingStudy | ImagingManifest)	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
image		0..*	BackboneElement	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
presentedForm	S	0..*	Attachment	Entire report as issued
contentType	S	1..1	code	Mime type of the content, with charset etc.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
DiagnosticReport.category	required	Diagnostic Service Section Codes
DiagnosticReport.code	preferred	Care Connect Report Code SnCT
DiagnosticReport.code.coding:nicip.code	required	InterweaveNICIP codes
DiagnosticReport.code.coding:loinc.code	required	LOINC Diagnostic Report Codes (a valid code from LOINC)

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	CareConnect-DiagnosticReport-1	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier for report Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
identifier:localIdentifier	SΣ	0..1	Identifier	Business identifier for report
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-diagnostic-report-identifier
value	SΣ	1..1	string	The Local diagnostic-report Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report as a whole.
category	SΣ	1..1	CodeableConcept	Service category Binding: Diagnostic Service Section Codes (required)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
code	SΣ	1..1	CodeableConcept	Name/Code for this diagnostic report Binding: Care Connect Report Code SnCT (preferred)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system Binding: Care Connect Report Code SnCT (extensible): A code from the SNOMED Clinical Terminology UK
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:nicip	Σ	0..1	Coding	Code defined by a terminology system
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: https://fhir.yhcr.nhs.uk/CodeSystem/Interweave-NICIP-1
code	SΣ	0..1	code	National Interim Clinical Imaging Procedure code Binding: InterweaveNICIP codes (required)
display	SΣ	0..1	string	Representation defined by the system
coding:loinc	Σ	0..1	Coding	Code defined by a terminology system
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	SΣ	0..1	code	LOINC code Binding: LOINC Diagnostic Report Codes (required)
display	SΣ	0..1	string	Representation defined by the system
subject	SΣ	1..1	Reference(CareConnectPatient1)	The subject of the report - for our purposes the patient
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	SΣ	0..1	Reference(CareConnect-Encounter-1)	Health care event when test ordered
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
effective[x]	SΣ	0..1		Clinically relevant time/time-period for report
effectiveDateTime			dateTime
effectivePeriod			Period
issued	SΣ	1..1	instant	DateTime this version was released
result	S	0..*	Reference(CareConnect-Observation-1)	Observations - simple, or complex nested groups
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
imagingStudy		0..*	Reference(ImagingStudy | ImagingManifest)	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
image	Σ	0..*	BackboneElement	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
link	Σ	1..1	Reference(Media)	Reference to the image source
presentedForm	S	0..*	Attachment	Entire report as issued
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.meta.security	extensible	All Security Labels
DiagnosticReport.meta.tag	example	Common Tags
DiagnosticReport.meta.tag:Source	example	Common Tags
DiagnosticReport.meta.tag:Provenance	example	Common Tags
DiagnosticReport.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.identifier.use	required	IdentifierUse
DiagnosticReport.identifier:localIdentifier.use	required	IdentifierUse
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	required	Diagnostic Service Section Codes
DiagnosticReport.code	preferred	Care Connect Report Code SnCT
DiagnosticReport.code.coding:snomedCT	extensible	Care Connect Report Code SnCT
DiagnosticReport.code.coding:nicip.code	required	InterweaveNICIP codes
DiagnosticReport.code.coding:loinc.code	required	LOINC Diagnostic Report Codes (a valid code from LOINC)
DiagnosticReport.presentedForm.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	CareConnect-DiagnosticReport-1	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier for report Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	Business identifier for report
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-diagnostic-report-identifier
value	SΣ	1..1	string	The Local diagnostic-report Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
basedOn		0..*	Reference(CareConnect-CarePlan-1 | CareConnect-MedicationRequest-1 | CareConnect-ReferralRequest-1 | CareConnect-ProcedureRequest-1)	What was requested
status	?!SΣ	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report as a whole.
category	SΣ	1..1	CodeableConcept	Service category Binding: Diagnostic Service Section Codes (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣ	1..1	CodeableConcept	Name/Code for this diagnostic report Binding: Care Connect Report Code SnCT (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system Binding: Care Connect Report Code SnCT (extensible): A code from the SNOMED Clinical Terminology UK
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:nicip	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: https://fhir.yhcr.nhs.uk/CodeSystem/Interweave-NICIP-1
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	National Interim Clinical Imaging Procedure code Binding: InterweaveNICIP codes (required)
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:loinc	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	LOINC code Binding: LOINC Diagnostic Report Codes (required)
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(CareConnectPatient1)	The subject of the report - for our purposes the patient
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	SΣ	0..1	Reference(CareConnect-Encounter-1)	Health care event when test ordered
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
effective[x]	SΣ	0..1		Clinically relevant time/time-period for report
effectiveDateTime			dateTime
effectivePeriod			Period
issued	SΣ	1..1	instant	DateTime this version was released
performer	Σ	0..*	BackboneElement	Participants in producing the report
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
role	Σ	0..1	CodeableConcept	Type of performer Binding: Procedure Performer Role Codes (example): Indicate a role of diagnostic report performer
actor	Σ	1..1	Reference(CareConnect-Organization-1 | CareConnect-Practitioner-1)	Practitioner or Organization participant
specimen		0..*	Reference(CareConnect-Specimen-1)	Specimens this report is based on
result	S	0..*	Reference(CareConnect-Observation-1)	Observations - simple, or complex nested groups
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
imagingStudy		0..*	Reference(ImagingStudy | ImagingManifest)	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
image	Σ	0..*	BackboneElement	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
comment		0..1	string	Comment about the image (e.g. explanation)
link	Σ	1..1	Reference(Media)	Reference to the image source
conclusion		0..1	string	Clinical Interpretation of test results
codedDiagnosis		0..*	CodeableConcept	Codes for the conclusion Binding: Care Connect Finding Code (preferred): A SNOMED Coded finding for the test report.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system Binding: Care Connect Finding Code (extensible): A code from the SNOMED Clinical Terminology UK
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
presentedForm	S	0..*	Attachment	Entire report as issued
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data		0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	uri	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date attachment was first created
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.meta.security	extensible	All Security Labels
DiagnosticReport.meta.tag	example	Common Tags
DiagnosticReport.meta.tag:Source	example	Common Tags
DiagnosticReport.meta.tag:Provenance	example	Common Tags
DiagnosticReport.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.identifier.use	required	IdentifierUse
DiagnosticReport.identifier.type	extensible	Identifier Type Codes
DiagnosticReport.identifier:localIdentifier.use	required	IdentifierUse
DiagnosticReport.identifier:localIdentifier.type	extensible	Identifier Type Codes
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	required	Diagnostic Service Section Codes
DiagnosticReport.code	preferred	Care Connect Report Code SnCT
DiagnosticReport.code.coding:snomedCT	extensible	Care Connect Report Code SnCT
DiagnosticReport.code.coding:nicip.code	required	InterweaveNICIP codes
DiagnosticReport.code.coding:loinc.code	required	LOINC Diagnostic Report Codes (a valid code from LOINC)
DiagnosticReport.performer.role	example	Procedure Performer Role Codes
DiagnosticReport.codedDiagnosis	preferred	Care Connect Finding Code
DiagnosticReport.codedDiagnosis.coding:snomedCT	extensible	Care Connect Finding Code
DiagnosticReport.presentedForm.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes
DiagnosticReport.presentedForm.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

Differential View

This structure is derived from CareConnect-DiagnosticReport-1

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	CareConnect-DiagnosticReport-1	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	S	0..1	id	Logical id of this artifact
meta
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for identifier		0..*	Identifier	Business identifier for report Slice: Unordered, Open by value:system
identifier:localIdentifier	S	0..1	Identifier	Business identifier for report
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-diagnostic-report-identifier
value	S	1..1	string	The Local diagnostic-report Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
status	S	1..1	code	registered | partial | preliminary | final +
category	S	1..1	CodeableConcept	Service category Binding: Diagnostic Service Section Codes (required)
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
code	S	1..1	CodeableConcept	Name/Code for this diagnostic report Binding: Care Connect Report Code SnCT (preferred)
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:nicip		0..1	Coding	Code defined by a terminology system
system	S	0..1	uri	Identity of the terminology system Fixed Value: https://fhir.yhcr.nhs.uk/CodeSystem/Interweave-NICIP-1
code	S	0..1	code	National Interim Clinical Imaging Procedure code Binding: InterweaveNICIP codes (required)
display	S	0..1	string	Representation defined by the system
coding:loinc		0..1	Coding	Code defined by a terminology system
system	S	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	S	0..1	code	LOINC code Binding: LOINC Diagnostic Report Codes (required)
display	S	0..1	string	Representation defined by the system
subject	S	1..1	Reference(CareConnectPatient1)	The subject of the report - for our purposes the patient
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
context	S	0..1	Reference(CareConnect-Encounter-1)	Health care event when test ordered
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
effective[x]	S	0..1	dateTime, Period	Clinically relevant time/time-period for report
issued	S	1..1	instant	DateTime this version was released
result	S	0..*	Reference(CareConnect-Observation-1)	Observations - simple, or complex nested groups
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
imagingStudy		0..*	Reference(ImagingStudy | ImagingManifest)	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
image		0..*	BackboneElement	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
presentedForm	S	0..*	Attachment	Entire report as issued
contentType	S	1..1	code	Mime type of the content, with charset etc.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
DiagnosticReport.category	required	Diagnostic Service Section Codes
DiagnosticReport.code	preferred	Care Connect Report Code SnCT
DiagnosticReport.code.coding:nicip.code	required	InterweaveNICIP codes
DiagnosticReport.code.coding:loinc.code	required	LOINC Diagnostic Report Codes (a valid code from LOINC)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	CareConnect-DiagnosticReport-1	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier for report Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
identifier:localIdentifier	SΣ	0..1	Identifier	Business identifier for report
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-diagnostic-report-identifier
value	SΣ	1..1	string	The Local diagnostic-report Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report as a whole.
category	SΣ	1..1	CodeableConcept	Service category Binding: Diagnostic Service Section Codes (required)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
code	SΣ	1..1	CodeableConcept	Name/Code for this diagnostic report Binding: Care Connect Report Code SnCT (preferred)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system Binding: Care Connect Report Code SnCT (extensible): A code from the SNOMED Clinical Terminology UK
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:nicip	Σ	0..1	Coding	Code defined by a terminology system
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: https://fhir.yhcr.nhs.uk/CodeSystem/Interweave-NICIP-1
code	SΣ	0..1	code	National Interim Clinical Imaging Procedure code Binding: InterweaveNICIP codes (required)
display	SΣ	0..1	string	Representation defined by the system
coding:loinc	Σ	0..1	Coding	Code defined by a terminology system
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	SΣ	0..1	code	LOINC code Binding: LOINC Diagnostic Report Codes (required)
display	SΣ	0..1	string	Representation defined by the system
subject	SΣ	1..1	Reference(CareConnectPatient1)	The subject of the report - for our purposes the patient
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	SΣ	0..1	Reference(CareConnect-Encounter-1)	Health care event when test ordered
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
effective[x]	SΣ	0..1		Clinically relevant time/time-period for report
effectiveDateTime			dateTime
effectivePeriod			Period
issued	SΣ	1..1	instant	DateTime this version was released
result	S	0..*	Reference(CareConnect-Observation-1)	Observations - simple, or complex nested groups
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
imagingStudy		0..*	Reference(ImagingStudy | ImagingManifest)	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
image	Σ	0..*	BackboneElement	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
link	Σ	1..1	Reference(Media)	Reference to the image source
presentedForm	S	0..*	Attachment	Entire report as issued
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.meta.security	extensible	All Security Labels
DiagnosticReport.meta.tag	example	Common Tags
DiagnosticReport.meta.tag:Source	example	Common Tags
DiagnosticReport.meta.tag:Provenance	example	Common Tags
DiagnosticReport.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.identifier.use	required	IdentifierUse
DiagnosticReport.identifier:localIdentifier.use	required	IdentifierUse
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	required	Diagnostic Service Section Codes
DiagnosticReport.code	preferred	Care Connect Report Code SnCT
DiagnosticReport.code.coding:snomedCT	extensible	Care Connect Report Code SnCT
DiagnosticReport.code.coding:nicip.code	required	InterweaveNICIP codes
DiagnosticReport.code.coding:loinc.code	required	LOINC Diagnostic Report Codes (a valid code from LOINC)
DiagnosticReport.presentedForm.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	CareConnect-DiagnosticReport-1	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier for report Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	Business identifier for report
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-diagnostic-report-identifier
value	SΣ	1..1	string	The Local diagnostic-report Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
basedOn		0..*	Reference(CareConnect-CarePlan-1 | CareConnect-MedicationRequest-1 | CareConnect-ReferralRequest-1 | CareConnect-ProcedureRequest-1)	What was requested
status	?!SΣ	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report as a whole.
category	SΣ	1..1	CodeableConcept	Service category Binding: Diagnostic Service Section Codes (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣ	1..1	CodeableConcept	Name/Code for this diagnostic report Binding: Care Connect Report Code SnCT (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system Binding: Care Connect Report Code SnCT (extensible): A code from the SNOMED Clinical Terminology UK
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:nicip	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: https://fhir.yhcr.nhs.uk/CodeSystem/Interweave-NICIP-1
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	National Interim Clinical Imaging Procedure code Binding: InterweaveNICIP codes (required)
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:loinc	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	LOINC code Binding: LOINC Diagnostic Report Codes (required)
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(CareConnectPatient1)	The subject of the report - for our purposes the patient
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	SΣ	0..1	Reference(CareConnect-Encounter-1)	Health care event when test ordered
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
effective[x]	SΣ	0..1		Clinically relevant time/time-period for report
effectiveDateTime			dateTime
effectivePeriod			Period
issued	SΣ	1..1	instant	DateTime this version was released
performer	Σ	0..*	BackboneElement	Participants in producing the report
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
role	Σ	0..1	CodeableConcept	Type of performer Binding: Procedure Performer Role Codes (example): Indicate a role of diagnostic report performer
actor	Σ	1..1	Reference(CareConnect-Organization-1 | CareConnect-Practitioner-1)	Practitioner or Organization participant
specimen		0..*	Reference(CareConnect-Specimen-1)	Specimens this report is based on
result	S	0..*	Reference(CareConnect-Observation-1)	Observations - simple, or complex nested groups
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
imagingStudy		0..*	Reference(ImagingStudy | ImagingManifest)	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
image	Σ	0..*	BackboneElement	DISCOURAGED: Intention is primarily to share reports and results, not raw images. Will be ignored if populated.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
comment		0..1	string	Comment about the image (e.g. explanation)
link	Σ	1..1	Reference(Media)	Reference to the image source
conclusion		0..1	string	Clinical Interpretation of test results
codedDiagnosis		0..*	CodeableConcept	Codes for the conclusion Binding: Care Connect Finding Code (preferred): A SNOMED Coded finding for the test report.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..*	Coding	Code defined by a terminology system Binding: Care Connect Finding Code (extensible): A code from the SNOMED Clinical Terminology UK
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
presentedForm	S	0..*	Attachment	Entire report as issued
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data		0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	uri	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date attachment was first created
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.meta.security	extensible	All Security Labels
DiagnosticReport.meta.tag	example	Common Tags
DiagnosticReport.meta.tag:Source	example	Common Tags
DiagnosticReport.meta.tag:Provenance	example	Common Tags
DiagnosticReport.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.identifier.use	required	IdentifierUse
DiagnosticReport.identifier.type	extensible	Identifier Type Codes
DiagnosticReport.identifier:localIdentifier.use	required	IdentifierUse
DiagnosticReport.identifier:localIdentifier.type	extensible	Identifier Type Codes
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	required	Diagnostic Service Section Codes
DiagnosticReport.code	preferred	Care Connect Report Code SnCT
DiagnosticReport.code.coding:snomedCT	extensible	Care Connect Report Code SnCT
DiagnosticReport.code.coding:nicip.code	required	InterweaveNICIP codes
DiagnosticReport.code.coding:loinc.code	required	LOINC Diagnostic Report Codes (a valid code from LOINC)
DiagnosticReport.performer.role	example	Procedure Performer Role Codes
DiagnosticReport.codedDiagnosis	preferred	Care Connect Finding Code
DiagnosticReport.codedDiagnosis.coding:snomedCT	extensible	Care Connect Finding Code
DiagnosticReport.presentedForm.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes
DiagnosticReport.presentedForm.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

This structure is derived from CareConnect-DiagnosticReport-1

Summary

Mandatory: 4 elements (15 nested mandatory elements)
Must-Support: 29 elements
Fixed Value: 5 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• CareConnectPatient1 (https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Patient-1)

Slices

This structure defines the following Slices:

• The element DiagnosticReport.meta.tag is sliced based on the value of value:system
• The element DiagnosticReport.identifier is sliced based on the value of value:system
• The element DiagnosticReport.code.coding is sliced based on the value of value:system