SNOMED CT Implementation Guide for the LOINC Ontology

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Represent Laboratory Results with FHIR

In the context of managing lab result data, FHIR (Fast Healthcare Interoperability Resources) offers two key resources: the Observation resource and the DiagnosticReport resource. Each plays a distinct role in representing and conveying lab results, and together they provide a comprehensive view of the lab data.

Lab Result Resources


FHIR Observation

The Observation resource is used to represent the actual result of a laboratory test. It includes details such as:

  • Test Results: The specific findings or measurements from the test (e.g., blood glucose levels, cholesterol levels).
  • Units of Measurement: How the results are quantified (e.g., mg/dL).
  • Reference Ranges: Normal value ranges for comparison.
  • Observation Date and Time: When the result was recorded.
  • Use: This resource focuses on the raw data from the test, providing a granular view of each result.

Terminology Binding

Data element

BindingComment
observation.code

^ 635121010000106 |LOINC Observation Reference Set|

Binds to the members of the simple type reference set containing the references to the SNOMED CT concepts representing a LOINC Observable term
observation.interpretation

<  404684003 |Clinical finding (finding)|

Ensures that the interpretation uses concepts from the clinical finding hierarchy, which includes concepts representing the results of an observation.


Example

{
  "resourceType": "Observation",
  "id": "obs001",
  "status": "final",
  "code": {
    "coding": [
      {
        "system": "http://loinc.org",
        "code": "15074-8",
        "display": "Glucose [Moles/volume] in Blood"
      },
      {
        "system": "http://snomed.info/sct",
        "code": "234561010000108",
        "display": "Substance concentration of glucose in blood at point in time (observable entity)"
      }
    ],
    "text": "Blood glucose measurement"
  },
  "subject": {
    "reference": "Patient/m001",
    "display": "Noah Lee"
  },
  "effectiveDateTime": "2024-02-20T09:15:00+00:00",
  "issued": "2024-02-20T10:00:00+00:00",
  "performer": [
    {
      "reference": "Practitioner/p005",
      "display": "O. Wilson"
    }
  ],
  "valueQuantity": {
    "value": 6.3,
    "unit": "mmol/L",
    "system": "http://snomed.info/sct",
    "code": "258813002",
    "display": "Millimole/liter (qualifier value)"
  },
  "interpretation": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "444780001",
          "display": "Glucose in blood specimen above reference range (finding)"
        }
      ]
    }
  ],
  "referenceRange": [
    {
      "low": {
        "value": 3.1,
        "unit": "mmol/L",
        "system": "http://snomed.info/sct",
        "code": "258813002",
        "display": "Millimole/liter (qualifier value)"
      },
      "high": {
        "value": 6.2,
        "unit": "mmol/L",
        "system": "http://snomed.info/sct",
        "code": "258773002",
        "display": "Millimoles per liter (qualifier value)"
      }
    }
  ]
}


FHIR DiagnosticReport

The DiagnosticReport resource adds additional context and information to the results presented by the Observation resource. It includes:

  • Summary of Results: An aggregated view of all related observations and their interpretations.
  • Clinical Interpretation: Comments or interpretations provided by the laboratory or a medical professional, which may help in understanding the results in a clinical context.
  • Report Status: Indicates whether the report is final, preliminary, or in draft form.
  • Test Details: Information about the test performed, including the test code, description, and any relevant procedural details.
  • Ordering Information: References to the original order request and any relevant patient and provider details.


Terminology Binding

Data elementBinding
DiagnosticReport.code

^  635121010000106 |LOINC Observation Reference Set|

Enforce reporting using the observable entity
DiagnosticReport.conclusionCode


404684003 |Clinical finding (finding)|

Enforce reporting using the clinical findings to report the result of the test(-s).

Example

This FHIR DiagnosticReport example below demonstrates how multiple Observation resources can be referenced within a single diagnostic report, specifically for a blood glucose test panel. It provides a structured approach to representing laboratory results using both LOINC and SNOMED CT codes.

In this example, the primary focus is on a blood glucose measurement (Observation/Obs001 exemplified above), but the report also includes other relevant tests commonly performed in diabetes assessment and metabolic health monitoring. These additional observations help provide a comprehensive clinical picture and are essential in diagnosing and managing conditions such as diabetes mellitus, insulin resistance, and cardiovascular risk factors.

Key Features of the Example

  • References multiple Observation resources related to metabolic and cardiovascular health.
  • Uses both LOINC and SNOMED CT codes in the code field to enhance compatibility.
  • Includes SNOMED CT codes for interpretation and conclusion, making the report machine-readable and clinically relevant.


{
  "resourceType": "DiagnosticReport",
  "id": "dr001",
  "status": "final",
  "category": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v2-0074",
          "code": "LAB",
          "display": "Laboratory"
        }
      ]
    }
  ],
  "code": {
    "coding": [
      {
        "system": "http://loinc.org",
        "code": "11502-2"????,
        "display": "Glucose panel - Blood"
      },
      {
        "system": "http://snomed.info/sct",
        "code": "????",
        "display": "Blood glucose test report (observable entity)"
      }
    ],
    "text": "Blood Glucose Test Report"
  },
  "subject": {
    "reference": "Patient/m001",
    "display": "Noah Lee"
  },
  "effectiveDateTime": "2024-02-20T10:30:00+00:00",
  "issued": "2024-02-20T11:00:00+00:00",
  "performer": [
    {
      "reference": "Practitioner/p005",
      "display": "O. Wilson"
    }
  ],
  "result": [
    {
      "reference": "Observation/obs001",
      "display": "Blood glucose measurement"
    },
    {
      "reference": "Observation/obs002",
      "display": "HbA1c (Glycated Hemoglobin)"
    },
    {
      "reference": "Observation/obs003",
      "display": "Serum Insulin Level"
    },
    {
      "reference": "Observation/obs004",
      "display": "C-Peptide Measurement"
    },
    {
      "reference": "Observation/obs005",
      "display": "Blood Ketones (Beta-hydroxybutyrate)"
    },
    {
      "reference": "Observation/obs006",
      "display": "Lipid Panel"
    },
    {
      "reference": "Observation/obs007",
      "display": "Blood Pressure"
    }
  ],
  "conclusion": "This diagnostic report integrates multiple laboratory observations, including blood glucose, HbA1c, serum insulin, and lipid profile. The blood glucose level is above the reference range, suggesting potential hyperglycemia. Further evaluation of HbA1c and lipid parameters is recommended.",
  "conclusionCode": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "444780001",
          "display": "444780001 |Glucose in blood specimen above reference range (finding)|"
        }
      ]
    }
  ]
}


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