Labs in diagnosticReport and observation

[Yong Wu]

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• Issue Summary: labs are not showing in diagnosticReport.
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I saw the similar question from 2017. Currently labs are not displayed in diagnosticReport. Individual components are in the observation. Based on FHIR spec:

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Laboratory reports, pathology reports, and imaging reports should be represented using the DiagnosticReport resource. The Observation resource is referenced by the DiagnosticReport to provide the atomic results for a particular investigation.

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In the response from 2017, it says that this is on the project list. Is this done now?

-Yong

[Jenni Syed (Cerner)]

Hi Yong,

Discrete observations for labs are really all that Millennium tracks on, and those are exposed in Observation. The only additional detail that will get exposed through DiagnosticReport is the grouping (EG: CBC level) with links back to the discrete Observations. We have not exposed that part of DiagnosticReport yet. Are you specifically looking for the grouping?

Regards,

Jenni

[Yong Wu]

yes, what I am looking for is a diagnosticReport showing the lab which is the group of the various links to observations which contain component level values. If there is any result note or comments associated with the lab, I would expect it to be in the DiagnosticReport as well. 

-Yong

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[Jenni Syed (Cerner)]

Hi Yong,

There would be no such additional information at the *group* level in our system. All comments etc are on the discrete observations themselves, along with the normalcy ranges etc. The only additional information that would be exposed is the grouping of RBC, WBC, etc into a CBC vs. just getting the RBC, WBC discretes as you can today.

Regards,

Jenni

[Yong Wu]

Hi Jenni,

Thank you for the info. Is there any patient that has diagnosticReport that is a group of observations?

Thanks,

Yong

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[Jenni Syed (Cerner)]

Yong,

There is no grouping exposed today, only discretes via Observations per the US Core profile. You can see some patients with example data listed in our test document: https://groups.google.com/d/msg/cerner-fhir-developers/edPUbVPIag0/LgD4mGTXBAAJ

Thanks,

Jenni

[kevin maloy]

Hi --

+1 on making lab panels available in diagReport.

Providers often thing in terms of the panels of tests they are sending ... They ask themselves "Is the CBC normal?" a lot.

You can piece some of this together with timestamps, but my experience is that not all parts of a panel (like a CBC) result together.

The Rory Stauton case (https://www.nytimes.com/2012/07/12/nyregion/in-rory-stauntons-fight-for-his-life-signs-that-went-unheeded.html) highlights how parts of a panel can result at different times and how providers tend to think of panels.  If you don't remember, Rory was a young boy who was discharged from a ER in New York while a band count from a CBC was still pending.  His bands were extremely high and he later died of overwhelming sepsis.  Like all safety events, there was not one thing that went wrong but a series of things ... but not having access what belongs in a panel (ie bands that are still pending) doesn't help.

You could check ProcedureRequest and see if a manual diff is still pending in his case, but if you grouped results together and displayed as one, finalized panel, you run the risk of having a UI that potentially leads a provider to a bad action (ie discharge with incomplete results).

Whether having this functionality is specifically stated in USCDI or ARCH or Argonaut Data Query Guide is somewhat besides the point to me ... I think we all got into this FHIR thing to make things better, not potentially make work arounds that could hurt people.  For what it is worth, Epic supports this in diagReport, I am guessing because of the above safety issue.  I personally think lab viewers would be great, low hanging fruit to innovate within FHIR (and I've seen people make them with work arounds).  However, having seen near misses of incomplete panel results (bands, potassiums, platelets, etc) in clinical practice leads me to not build a lab viewer until panels are in diagReport.  

We all got into this FHIR thing to make things better, and we can, just need the right tools.

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[Jenni Syed (Cerner)]

Hi Kevin,

To be clear, we do plan on making this available in the future, and agree it is necessary. I was just trying to clarify above that the only additional (important) information that will be returned at that time is the concept of the group since Millennium itself doesn't have the concept of comments or normalcy at the CBC level. 

However, it is not the next item immediately up on the roadmap.

Regards,

~ Jenni

[alex.l...@gmail.com]

Was this ever implemented? I still don't see a way to link a DiagnosticReport to it's Observations.

Alex

[Michele Mottini]

They are linked via DiagnosticReport.result (?)

 - Michele

  CareEvolution

[alex.l...@gmail.com]

Is this logic missing from the public sandbox? I don't see any "result" for DiagnosticReport for Nancy and Joe SMART sample patients.