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Hi everyone - I had a question about how DiagnosticReport and ServiceRequest relate to observation resources.
Currently, to display “lab results” for a patient, we are fetching DiagnosticReport resources, and then fetching each referenced observation within the diagnosticReport's results array. This has served us mostly well, returning a wide variety of labs, imaging, etc for a patient. Our goal is to provide a view for a patient that groups all observations under a parent/context lab test.
However we had one patient give us feedback that some of his lab tests were not available/showing up in our application. Upon further review, we noticed that there was no DiagnosticReport generated for these observations, and in fact, the only way to contextualize them was through their associated ServiceRequest. Specifically, we saw these observations were linked via the “basedOn” field which all contained a reference to the relevant ServiceRequest.
A few questions this raises for us:
- Within Cerner - is DiagnosticReport the proper resource for contextualizing/grouping observations? DiagnosticReport does contain important information such as the provider, organization, etc. Or is serviceRequest preferable as an organizing tool (for example, using “basedOn” to see all observations related to a given CBC panel)? Or is there another resource that's better suited for us?
- Should (in theory) all observations be linked to a diagnosticReport? Would we expect to always have a diagnosticReport related to each observation and this data is an outlier?
- Would all panel labs (meaning lab tests comprised of more than one observation) be guaranteed to have a “basedOn” field that we can use to find the relevant serviceRequest? I see in the FHIR standard this field is optional, and I'm unsure if it's safe to rely on.
- Lastly, side question - do no Cerner R4 FHIR APIs support includes or revIncludes for resource searches like this? Ideally we'd like to do something like the below to make queries more efficient…but I've not come across support for these operations. In my opinion that's a major limitation of Cerner (compared to Epic or Google Fhir Store), where these type of common includes are supported…
- https//:fhir-url/ServiceRequest?patient=12345&_revInclude:Observation or
- https//:fhir-url/DiagnosticReport?patient=12345&_include:Observation