Diagnostic Report Sent Downstream Tag CodeSystem Code system

Canonical	../CodeSystem/diagnostic-report-sent-downstream
Status	draft · 1.26.0
Content	complete
Source	FSH · JSON

Records that the report ingest has completed its downstream handoff for this report. Carried as a tag on DiagnosticReport.meta.tag, where this is the tag's system.

A tag, not an extension. The address identifies the system of a Coding in meta.tag, which is why it is declared as a code system. The vocabulary is the unusual part: the codes are the literal strings true and false, the writer's rendering of a boolean.

It is an idempotency marker, not provenance. Its purpose is to stop a re-sent or replayed report being handed on twice, and to let a duplicate that was never handed on be handed on now. A consumer that needs to know what actually happened to a report should read AuditEvent or Provenance.

true does not guarantee anything received the report. The handoff is a custom operation on DiagnosticReport that the receiving server advertises in its CapabilityStatement; that operation is not part of this specification. Where the server does not advertise it, the handoff is skipped rather than failed, and the tag is written all the same. So true means the ingest reached the end of its handoff step for this report, and no more than that. A handoff that fails outright leaves the report untagged so it can be retried, which is why the absent state is the meaningful one.

false is representable but is not written. The vocabulary is closed by the boolean it is rendered from, so both codes are listed; only true is emitted. Read false exactly as an absent tag, compare case-insensitively, and treat anything that is not true as not handed on rather than as an error.

One tag per system, and this system carries one fact. A writer replaces any existing tag with this system rather than adding a second. The parallel record of the provincial send is a separate system, ../CodeSystem/diagnostic-report-acdr-sent, precisely so that the two can be held at once.

Nexus EMR writes this today at http://services.well.com/fhir/tags/diagnostic-reports/sent-downstream (FHIR-371): it is live in stored DiagnosticReport.meta.tag codings and in code, and is under migration to the canonical declared here. Write the canonical; expect both until the migration completes, and match both addresses exactly rather than deriving one from the other.

Code	Display	Definition
true	Handed on	The ingest completed its downstream handoff step for this report. Not a guarantee that a downstream system received it.
false	Not handed on	The ingest has not completed its downstream handoff for this report. Representable but not written by Nexus EMR; a reader should treat it exactly as an absent tag.