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Linking requests to multiple specimens. #87

Open thibaultmh opened 2 years ago

thibaultmh commented 2 years ago

Hi,

How should we link multiple specimens to a single observation? For example, a creatinine clearance observation can be configured in our system as a calculated result with two specimens. However, the international FHIR profile limits the observation.specimen link to max. 1 specimen reference.

I mailed the HL7 Belgian workgroup about this a few months ago and I got the following recommendations :

  1. One recommendation is that we use the values from the different measurements into different Observations and group all of them using derivedFrom into a single Observation. So, blood tests = Observation1, Urine = Observation2, Total result= Observation3, which is derivedFrom Observation1 and Observation2.

  2. Alternatively, we could use an extension like “additionalSpecimens” to capture the other specimens. That is actually one of the options on the table. But I think that this may be a bit more risky approach, because then we may lose some of the details about the individual results (datetime of the urine test vs blood test, etc.).

I prefer the second approach since it is more closely resembles the situation in our application. Moreover, it does not exclude the first approach. What are your thoughts on this?

Best, Thibault

bdc-ehealth commented 2 years ago

@costateixeira José, can you comment on this?

thibaultmh commented 2 years ago

An example with glucuse and two specimens:

MSH|^~\&|||||20220201163652||ORU^R01^ORU_R01|6730233880634243423|P|2.5||||||||| ORC|SC|OP_00001^ORBIS|OF_00001^Glims|OPGN0001^ORBIS|A||||20201010050505 OBR|1|OP_00001^ORBIS|OF_00001^Glims|GLUD^GLUD^L^L_GLUD^GLUD^LOINC|||""||||||||||||||||||P|||||||JVA&&&&&&&&L^20100228183010+0000 TQ1|||||||||A OBX|1|NM|GLU^GLU^L^L_GLU^GLU^LOINC||82.7|^^L|20 - 90|""|||P|||20100228080010+0000|^^L||||20100228183010+0000 NTE|1|L|Result External Comment|P SPM|1|SPM_OF_00001&Glims^SPM_OF_00001&Glims||SERUM^Serum^L^L_SERUM^Serum^LOINC||||||||||External Specimen Comment|||20100228080010+0000|20100228083010+0000||Y SPM|2|SPM_OF_00002&Glims^SPM_OF_00002&Glims||URINE^Urine^L^L_URINE^Urine^LOINC||||||||||External Specimen Comment Urine|||20100228080010+0000|20100228083010+0000||Y

bdc-ehealth commented 2 years ago

The WG postpones the issue until there is a question from the field.