DiagnosticReport Profile

Canonical	../StructureDefinition/nexus-emr-core-diagnosticreport
Status	draft · 1.26.0
Base	DiagnosticReport (constraint)
Source	FSH · JSON

Defines the Nexus EMR FHIR profile for DiagnosticReport resources, based on CA-Core constraints, for aggregating diagnostic reports (e.g., Lab, Imaging) from multiple EMRs.

FSH

The authored source of truth: resources/StructureDefinition-nexus-emr-core-diagnosticreport.fsh (edit on GitHub). One FSH file may define several related artifacts.

// NexusEmrCoreDiagnosticReport.fsh

Alias: $NexusEmrCoreDiagnosticReport = ../StructureDefinition/nexus-emr-core-diagnosticreport


// Profile Definition
Profile:        NexusEmrCoreDiagnosticReport
Parent:         DiagnosticReport
Id:             nexus-emr-core-diagnosticreport
Title:          "DiagnosticReport Profile"
Description:    "Defines the Nexus EMR FHIR profile for DiagnosticReport resources, based on CA-Core constraints, for aggregating diagnostic reports (e.g., Lab, Imaging) from multiple EMRs."
* ^url = $NexusEmrCoreDiagnosticReport // Canonical URL from alias
* ^status = #draft

// THE effective date for this profile (see the EffectiveDate / NoEffectiveDate
// RuleSets): one date concept per resource, declared here rather than guessed.
* insert EffectiveDate([[effectiveDateTime | effectivePeriod.start | issued]])

// Salient fields — the reader/render surface (see SalientField + the Salient RuleSet).
* insert Salient(code, code, coded)
* insert Salient(status, status, code)
* insert Salient(category, category, coded)
* insert Salient(effective, [[effectiveDateTime | effectivePeriod.start]], dateTime)
* insert Salient(issued, issued, dateTime)
* insert Salient(conclusion, conclusion, string)
// The report's attached narrative (the rendered lab/imaging report). Same `base64Binary` kind as
// DocumentReference.data: decoded on read, long-form for rendering and the prose budget. Without
// this a report's own text never reaches a reader — only its coded conclusion does. Rendered as
// `prose` (reader-facing) while the accessor stays `data` (element-faithful).
* insert SalientAs(data, [[presentedForm.first().data]], base64Binary, prose)

// SMART on FHIR exposure -- this resource is reachable by an app, and these are the
// permissions each operation costs (see SmartExposed + the SmartExposed RuleSet).
* insert SmartExposed(diagnosticreport)

* . ^short      = "Nexus EMR Diagnostic Report Core"
* . ^definition = """
  Represents diagnostic test results and findings, capturing key details
  like report status, code, subject, and result references using standard
  Nexus EMR references. Uses instance-specific identifiers for tracking
  diagnostic reports across systems.
  """

* meta.source 0..1 MS
* meta.source ^short = "Identifies EMR instance & pipeline version the resource came from"
* meta.source ^definition = "A URI that identifies the EMR pipeline and version from which this resource originated.  This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations."

* text 0..1 MS // Narrative element with human-readable summary
* text ^short = "Narrative"
* text ^definition = "A human-readable narrative summary of the NexusEmrCoreDiagnosticReport resource for human interpretation."  

// Identifier: A business identifier is recommended but not required (any system).
* identifier 0..* MS
* identifier.system 1..1
* identifier.value 1..1
* identifier ^short = "Business identifier(s) for diagnostic report"
* identifier ^definition = """
Unique identifiers for the diagnostic report.

A business identifier is recommended but not required (identifier is 0..*). Where available, carry the source-system identifier using the most appropriate system URI. No specific canonical system is mandated.

A source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](../guide/patterns/raw-codes.md).
"""


// Status: final, preliminary, amended, etc. Mandatory and MS.
* status 1..1 MS
* status ^short = "Where the report is in its lifecycle"
* status ^definition = "The status of the diagnostic report. Indicates whether the report is complete and verified."
* status ^comment = "This is a modifier element. Preliminary reports should be interpreted with caution."
* status from http://hl7.org/fhir/ValueSet/diagnostic-report-status (required)

// Code: Specific type of report (CBC, Chest X-ray). Mandatory and MS.
* code 1..1 MS
* code ^short = "Diagnostic report type with raw code support"
* insert SourceCoding(code)
* code ^definition = """
Type of diagnostic report (e.g., CBC, Chest X-ray, Lipid Panel).

REQUIRED: text element for human readability
RECOMMENDED: LOINC or other standard terminology when available
OPTIONAL: Raw EMR codes for source system preservation

Nexus EMR does not mandate a specific coding system for diagnostic report types.
The text element ensures human readability even when coded values are not recognized.
"""
* code.text 1..1 MS
* code.text ^short = "Human-readable report type description (required)"
* code.text ^definition = "Plain text representation of the diagnostic report type, required for all entries"


// Category: Service category with raw code support
* category 0..* MS
* category ^short = "Service category with raw code support"
* category ^definition = """
Classification of the clinical discipline, department or diagnostic service that created the report.

RECOMMENDED: Standard terminology codes (e.g., HL7 Diagnostic Service Section Codes)
OPTIONAL: Raw EMR codes for source system preservation

Multiple categories may be specified to classify the report in different ways.
"""


// Subject: Who the report is about. Mandatory and MS. Use identifier.
* subject 1..1 MS
* subject ^short = "The subject of the report - usually a patient"
* subject ^definition = "The patient who is the subject of the diagnostic report. Must reference using Nexus EMR patient identifier."
* subject ^comment = "References should use identifier-based references following Nexus EMR patterns."
* subject only Reference(NexusEmrCorePatient)

// Encounter: Associated healthcare event. Optional. Use identifier.
* encounter 0..1 MS
* encounter ^short = "Healthcare event when report was generated"
* encounter ^definition = "The encounter during which this diagnostic report was generated. Optional but provides important clinical context."
* encounter ^comment = "Linking to encounter helps establish the clinical context and timing of the diagnostic testing."
* encounter only Reference(NexusEmrCoreEncounter)

// Effective[x]: Clinically relevant time. Mandatory and MS.
* effective[x] 1..1 MS
* effective[x] ^short = "Clinically relevant time/time-period for report"
* effective[x] ^definition = "The time or time-period the observed values are related to. This is usually the time specimen was collected or imaging was performed."
* effective[x] ^comment = "For lab reports, this is typically when specimen was collected. For imaging, when the images were taken."
* effective[x] only dateTime or Period

// Issued: Date/time report was released
* issued ^short = "DateTime report was released"
* issued ^definition = "The date and time that this version of the report was made available to providers."
* issued ^comment = "May be different from the effective date, especially for amended reports."

// Result: Observations that are part of this report
* result ^short = "Observations that are part of this report"
* result ^definition = "References to the Observations that are part of this diagnostic report."
* result ^comment = "Individual results are represented as separate Observation resources."
* result only Reference(NexusEmrCoreObservation)

// Imaging linkage (FHIR-29): the imaging half of results viewing (PSD-417). The patient cache
// already traverses this containment edge; the profile now names the target.
// `imagingStudy` IS DELIBERATELY UNPROFILED AND NO LONGER MUST-SUPPORT, as of 1.22.0. It was
// `0..* MS` pointing at a `NexusEmrCoreImagingStudy` profile that this guide withdrew: nothing in
// this estate produces DICOM acquisition metadata, so the profile described a shape with no
// producer and this element required consumers to support a reference that is never populated.
// The element survives at its base R4 definition -- a report that DOES come from a system holding
// studies may still carry it -- but this guide makes no claim about it and asks nothing of a
// consumer. The imaging REPORT is the modelled artifact; see the intro page.
* imagingStudy ^comment = "Left at base R4. This guide withdrew its ImagingStudy profile in 1.22.0 and models the imaging report rather than the DICOM acquisition, so nothing here produces this reference and no consumer is required to resolve it."

// Review state (FHIR-29): who acknowledged this result and when; ABSENT = unreviewed.
// The Task inbox is the review workflow; this is the queryable state it stamps.
* extension contains NexusEmrReviewed named reviewed 0..1 MS
* extension[reviewed] ^short = "Review acknowledgement (absent = unreviewed)"
// MODALITY, on the report. R4 has no element for it here -- it is an `ImagingStudy` property, and
// this guide withdrew its ImagingStudy profile in 1.22.0 because nothing in this estate produces
// DICOM acquisition metadata. Imaging results are a required capability (ON RFP 1.5.4.2) and
// modality is one of the imaging report's expected fields, so without this the requirement has no
// home. It describes the DOCUMENT (this report came from a CT), which needs no PACS to be honest
// about. Absent on a laboratory report, which has no modality.
* extension contains NexusImagingModality named imagingModality 0..* MS
* extension[imagingModality] ^short = "Acquisition modality (imaging reports; repeats for PET-CT)"


// Conclusion: Clinical conclusion of the report
* conclusion ^short = "Clinical conclusion (interpretation) of test results"
* conclusion ^definition = "Concise and clinically contextualized summary conclusion of the diagnostic report."
* conclusion ^comment = "The narrative conclusion shall only contain filtered information from the report."

// Conclusion Code: Coded conclusions
* conclusionCode ^short = "Codes for the clinical conclusion"
* insert SourceCoding(conclusionCode)
* conclusionCode ^definition = "Coded representation of the conclusion."
* conclusionCode from http://hl7.org/fhir/ValueSet/clinical-findings (example)

// Presented Form: Rendered report (e.g., PDF). Optional.
* presentedForm 0..*
* presentedForm ^short = "Entire report as issued"
* presentedForm ^definition = "Rich text representation of the entire result as issued by the diagnostic service."
* presentedForm ^comment = "Multiple formats of the same report may be provided (e.g., PDF and HTML)."
* presentedForm.contentType 1..1
* presentedForm.contentType ^short = "Mime type of the content (e.g., application/pdf)"
* presentedForm.data 0..1
* presentedForm.data ^short = "Data inline, base64 encoded"
* presentedForm.url 0..1