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4.17 Resource DiagnosticOrder - Content

A request for a diagnostic investigation service to be performed.

4.17.1 Scope and Usage

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

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

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

4.17.2 Boundaries and Relationships

Note that the Diagnostic Order itself is not a request to perform the investigation - it is just a record of the fact that a request was made. To actually request that a diagnostic procedure be performed, additional workflow beyond sumply the existence of a Diagnostic Order is required. This can be achieved by using an Order resource, with the Diagnostic Order referenced from the Order.details , or by using the Diagnostic Order resource in the context of of an messaging or service workflow where the request is explicit or implicit.

4.17.3 Resource Content

DiagnosticOrder ( Resource ) Who or what the investigation is to be performed on. This is usually a human patient, but diagnostic tests can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans) subject : Resource ( Patient | Group | Location | Device ) 1..1 The practitioner that holds legal responsibility for ordering the investigation orderer : Resource ( Practitioner ) 0..1 Identifiers assigned to this order by the order or by the receiver identifier : Identifier 0..* An encounter that provides additional informaton about the healthcare context in which this request is made encounter : Resource ( Encounter ) 0..1 An explanation or justification for why this diagnostic investigation is being requested clinicalNotes : string 0..1 One or more specimens that the diagnostic investigation is about specimen : Resource ( Specimen ) 0..* The status of the order status : code 0..1 << The status of a diagnostic order DiagnosticOrderStatus >> The clinical priority associated with this order priority : code 0..1 << The clinical priority of a diagnostic order DiagnosticOrderPriority >> Event The status for the event status : code 1..1 << The status of a diagnostic order DiagnosticOrderStatus >> Additional information about the event that occurred - e.g. if the status remained unchanged description : CodeableConcept 0..1 << Additional information about an event that occurred to a diagnostic order - e.g. if the status remained unchanged DIagnosticOrderEventDescription >> The date/time at which the event occurred dateTime : dateTime 1..1 The person who was responsible for performing or recording the action actor : Resource ( Practitioner | Device ) 0..1 Item A code that identifies a particular diagnostic investigation, or panel of investigations, that have been requested code : CodeableConcept 1..1 << Codes for tests/services that can be performed by diagnostic services DiagnosticRequests >> If the item is related to a specific speciment specimen : Resource ( Specimen ) 0..* Anatomical location where the request test should be performed bodySite : CodeableConcept 0..1 << Codes describing anatomical locations. May include laterality BodySite >> The status of this individual item within the order status : code 0..1 << The status of a diagnostic order DiagnosticOrderStatus >> A summary of the events of interest that have occurred as the request is processed. E.g. when the order was made, various processing steps (specimens received), when it was completed event 0..* A summary of the events of interest that have occurred as this item of the request is processed event 0..* The specific diagnostic investigations that are requested as part of this request. Sometimes, there can only be one item per request, but in most contexts, more than one investigation can be requested item 0..*

This resource is referenced by CarePlan , DiagnosticReport and ImagingStudy 

<DiagnosticOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: extension, modifierExtension, language, text, and contained -->
 <subject><!-- 1..1 Resource(Patient|Group|Location|Device) Who and/or what test is about --></subject>
 <orderer><!-- 0..1 Resource(Practitioner) Who ordered the test --></orderer>
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <encounter><!-- 0..1 Resource(Encounter) 
     The encounter that this diagnostic order is associated with --></encounter>
 <clinicalNotes value="[string]"/><!-- 0..1 Explanation/Justification for test -->
 <specimen><!-- 0..* Resource(Specimen) If the whole order relates to specific specimens --></specimen>
 <status value="[code]"/><!-- 0..1 requested | received | accepted | in progress | review | completed | suspended | rejected | failed -->
 <priority value="[code]"/><!-- 0..1 routine | urgent | stat | asap -->
 <event>  <!-- 0..* A list of events of interest in the lifecycle -->
  <status value="[code]"/><!-- 1..1 requested | received | accepted | in progress | review | completed | suspended | rejected | failed -->
  <description><!-- 0..1 CodeableConcept More information about the event and it's context --></description>
  <dateTime value="[dateTime]"/><!-- 1..1 The date at which the event happened -->
  <actor><!-- 0..1 Resource(Practitioner|Device) Who recorded or did this --></actor>
 </event>
 <item>  <!-- 0..* The items the orderer requested -->
  <code><!-- 1..1 CodeableConcept Code to indicate the item (test or panel) being ordered --></code>
  <specimen><!-- 0..* Resource(Specimen) If this item relates to specific specimens --></specimen>
  <bodySite><!-- 0..1 CodeableConcept Location of requested test (if applicable) --></bodySite>
  <status value="[code]"/><!-- 0..1 requested | received | accepted | in progress | review | completed | suspended | rejected | failed -->
  <event><!-- 0..* Content as for DiagnosticOrder.event Events specific to this item --></event>
 </item>
</DiagnosticOrder>

Alternate definitions: Schema / Schematron , Resource Profile

4.17.3.1 Terminology Bindings

Path Definition Type Reference
DiagnosticOrder.status
DiagnosticOrder.event.status
DiagnosticOrder.item.status 		The status of a diagnostic order Fixed http://hl7.org/fhir/diagnostic-order-status
DiagnosticOrder.priority The clinical priority of a diagnostic order Fixed http://hl7.org/fhir/diagnostic-order-priority
DiagnosticOrder.event.description Additional information about an event that occurred to a diagnostic order - e.g. if the status remained unchanged Example http://hl7.org/fhir/vs/diagnostic-order-event
DiagnosticOrder.item.code Codes for tests/services that can be performed by diagnostic services Incomplete http://hl7.org/fhir/vs/diagnostic-requests
DiagnosticOrder.item.bodySite Codes describing anatomical locations. May include laterality Example http://hl7.org/fhir/vs/body-site

4.17.4 Notes:

4.17.5 Search Parameters

Search parameters for this resource. The standard parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Paths
_id token The logical resource id associated with the resource (must be supported by all servers)
_language token The language of the resource
actor reference Who recorded or did this DiagnosticOrder.event.actor, DiagnosticOrder.item.event.actor
( Device , Practitioner )
bodysite token Location of requested test (if applicable) DiagnosticOrder.item.bodySite
code token Code to indicate the item (test or panel) being ordered DiagnosticOrder.item.code
encounter reference The encounter that this diagnostic order is associated with DiagnosticOrder.encounter
( Encounter )
event-date date The date at which the event happened DiagnosticOrder.event.dateTime
event-status token requested | received | accepted | in progress | review | completed | suspended | rejected | failed DiagnosticOrder.event.status
event-status-date composite A combination of past-status and date
identifier token Identifiers assigned to this order DiagnosticOrder.identifier
item-date date The date at which the event happened DiagnosticOrder.item.event.dateTime
item-past-status token requested | received | accepted | in progress | review | completed | suspended | rejected | failed DiagnosticOrder.item.event.status
item-status token requested | received | accepted | in progress | review | completed | suspended | rejected | failed DiagnosticOrder.item.status
item-status-date composite A combination of item-past-status and item-date
orderer reference Who ordered the test DiagnosticOrder.orderer
( Practitioner )
specimen reference If the whole order relates to specific specimens DiagnosticOrder.specimen, DiagnosticOrder.item.specimen
( Specimen )
status token requested | received | accepted | in progress | review | completed | suspended | rejected | failed DiagnosticOrder.status
subject reference Who and/or what test is about DiagnosticOrder.subject
( Device , Location , Patient , Group )
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