FHIR 格式的 COVID-19 诊断测试答案

【问题标题】：COVID-19 Diagnostic Test in FHIR formatFHIR 格式的 COVID-19 诊断测试
【发布时间】：2021-06-22 12:37:53
【问题描述】：

我不太熟悉 FHIR 数据格式，需要一些帮助。故事是，所有注册的实验室都会在我们的数据库中发送患者 COVID-19 诊断测试。所以他们提供的信息是

患者基本信息
用户参加测试的实验室信息（实验室名称、联系方式和地址）
测试类型（RNA、PCR、抗原或抗体测试）
测试结果（阳性或阴性）

我希望从HERE 遵循这种格式。但我不确定我应该使用哪个 LOINC 代码，以及如何判断结果是肯定的还是否定的。

{
  "resourceType": "ValueSet",
  "id": "Covid19Labs",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This value set includes codes based on the following rules:</p><ul><li>Import all the codes that are contained in <a href=\"ValueSet-SARSCoV2Labs.html\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.109</a></li><li>Include these codes as defined in <a href=\"http://loinc.org\"><code>http://loinc.org</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94307-6.html\">94307-6</a></td><td>SARS-CoV-2 (COVID-19) N gene [Presence] in Unspecified specimen by Nucleic acid amplification using CDC primer-probe set N1</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94308-4.html\">94308-4</a></td><td>SARS-CoV-2 (COVID-19) N gene [Presence] in Unspecified specimen by Nucleic acid amplification using CDC primer-probe set N2</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94309-2.html\">94309-2</a></td><td>SARS-CoV-2 (COVID-19) RNA [Presence] in Unspecified specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94310-0.html\">94310-0</a></td><td>SARS-like coronavirus N gene [Presence] in Unspecified specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94314-2.html\">94314-2</a></td><td>SARS-CoV-2 (COVID-19) RdRp gene [Presence] in Unspecified specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94315-9.html\">94315-9</a></td><td>SARS-related coronavirus E gene [Presence] in Unspecified specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94316-7.html\">94316-7</a></td><td>SARS-CoV-2 (COVID-19) N gene [Presence] in Unspecified specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94500-6.html\">94500-6</a></td><td>SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94533-7.html\">94533-7</a></td><td>SARS-CoV-2 (COVID-19) N gene [Presence] in Respiratory specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94534-5.html\">94534-5</a></td><td>SARS-CoV-2 (COVID-19) RdRp gene [Presence] in Respiratory specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94559-2.html\">94559-2</a></td><td>SARS-CoV-2 (COVID-19) ORF1ab region [Presence] in Respiratory specimen by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94759-8.html\">94759-8</a></td><td>SARS-CoV-2 (COVID-19) RNA [Presence] in Nasopharynx by NAA with probe detection</td></tr><tr><td><a href=\"http://details.loinc.org/LOINC/94558-4.html\">94558-4</a></td><td>SARS-CoV-2 (COVID-19) Ag [Presence] in Respiratory specimen by Rapid immunoassay</td></tr></table></li></ul></div>"
  },
  "url": "http://hl7.org/fhir/uv/saner/ValueSet/Covid19Labs",
  "version": "0.1.0",
  "name": "Covid19Labs",
  "title": "COVID-19 Diagnostic Test",
  "status": "active",
  "date": "2021-06-09T20:53:59+00:00",
  "publisher": "HL7 International Public Health Workgroup",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org/Special/committees/pher/index.cfm"
        }
      ]
    },
    {
      "telecom": [
        {
          "system": "email",
          "value": "pher@lists.hl7.org"
        }
      ]
    },
    {
      "name": "HL7 Public Health Workgroup",
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org/Special/committees/pher/index.cfm"
        }
      ]
    },
    {
      "name": "Keith W. Boone",
      "telecom": [
        {
          "system": "email",
          "value": "mailto:kboone@ainq.com"
        }
      ]
    }
  ],
  "description": "Codes for COVID-19 Diagnostic Tests",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001"
        }
      ]
    }
  ],
  "copyright": "This material contains content from LOINC (http://loinc.org). LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at LOINC/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc",
  "compose": {
    "include": [
      {
        "valueSet": [
          "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.109"
        ]
      },
      {
        "system": "http://loinc.org",
        "concept": [
          {
            "code": "94307-6",
            "display": "SARS-CoV-2 (COVID-19) N gene [Presence] in Unspecified specimen by Nucleic acid amplification using CDC primer-probe set N1"
          },
          {
            "code": "94308-4",
            "display": "SARS-CoV-2 (COVID-19) N gene [Presence] in Unspecified specimen by Nucleic acid amplification using CDC primer-probe set N2"
          },
          {
            "code": "94309-2",
            "display": "SARS-CoV-2 (COVID-19) RNA [Presence] in Unspecified specimen by NAA with probe detection"
          },
          {
            "code": "94310-0",
            "display": "SARS-like coronavirus N gene [Presence] in Unspecified specimen by NAA with probe detection"
          },
          {
            "code": "94314-2",
            "display": "SARS-CoV-2 (COVID-19) RdRp gene [Presence] in Unspecified specimen by NAA with probe detection"
          },
          {
            "code": "94315-9",
            "display": "SARS-related coronavirus E gene [Presence] in Unspecified specimen by NAA with probe detection"
          },
          {
            "code": "94316-7",
            "display": "SARS-CoV-2 (COVID-19) N gene [Presence] in Unspecified specimen by NAA with probe detection"
          },
          {
            "code": "94500-6",
            "display": "SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection"
          },
          {
            "code": "94533-7",
            "display": "SARS-CoV-2 (COVID-19) N gene [Presence] in Respiratory specimen by NAA with probe detection"
          },
          {
            "code": "94534-5",
            "display": "SARS-CoV-2 (COVID-19) RdRp gene [Presence] in Respiratory specimen by NAA with probe detection"
          },
          {
            "code": "94559-2",
            "display": "SARS-CoV-2 (COVID-19) ORF1ab region [Presence] in Respiratory specimen by NAA with probe detection"
          },
          {
            "code": "94759-8",
            "display": "SARS-CoV-2 (COVID-19) RNA [Presence] in Nasopharynx by NAA with probe detection"
          },
          {
            "code": "94558-4",
            "display": "SARS-CoV-2 (COVID-19) Ag [Presence] in Respiratory specimen by Rapid immunoassay"
          }
        ]
      }
    ]
  }
}

知道怎么做吗？提前致谢

【问题讨论】：

附带说明，请注意大多数实验室不支持导出 FHIR 结果，因此您最好尝试接收 HL7 v2 消息。

标签： hl7-fhir

【解决方案1】：

阿兹里，以下是 SARS CoV 2（COVID-19 的病原体）实验室测试的观察实例的示例。

    {
      "resourceType" : "Observation",
      "id" : "SARS_CoV2_example",
      "meta" : {
      "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/instance-name",
            "valueString" : "COVID-Example"
          },
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/instance-description",
            "valueMarkdown" : "This is an example of a lab test for SARS CoV 2."
          }
        ],
        "versionId" : "1",
        "lastUpdated" : "2021-06-22T15:29:57.818+00:00",
        "profile" : [
 "http://fhir.logicahealth.org/covid19/StructureDefinition/SARScoronavirus2AbIgGPlusIgMPrThrPtSerPlasOrdIALabObs"
    ]
  },
      "status" : "final",
      "category" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/observation- 
                           category",
              "code" : "laboratory",
              "display" : "Laboratory"
            }
          ],
          "text" : "Laboratory"
        }
      ],
      "code" : {
    "coding" : [
      {
        "system" : "http://loinc.org",
        "code" : "94547-7",
        "display" : "SARS-CoV-2 (COVID-19) IgG+IgM Ab [Presence] in Serum or Plasma 
    by Immunoassay"
          }
        ],
        "text" : "SARS-CoV-2 (COVID-19) IgG+IgM Ab [Presence] in Serum or Plasma by 
    Immunoassay"
      },
      "subject" : {
        "reference" : "Patient/1234",
      },
      "effectiveDateTime" : "2021-06-05",
      "performer": "Organization/123",
      "valueCodeableConcept" : {
        "system" : "http://snomed.info/sct",
        "value" : "10828004",
        "display": "Positive (qualifier value)"
      }
    }

患者信息是对患者资源实例的引用。对于此示例，它可能如下所示：

{
"resourceType": "Patient",
"id": "1234",
"lastUpdated": "2021-06-22T15:29:57.818+00:00",
"identifier": [
    {
        "system": "http://example_hopsital.org/EHR",
        "value": "143762_XYZ"
    }
],
"name": [
    {
        "given": "example",
        "family": "Patient"
    }
],
"birthDate": "2003-02-14"
}

同样，实验室信息是对组织资源实例的引用，可能如下所示：

{
    "resourceType": "Organization",
    "id": "123",
    "lastUpdated": "2021-06-22T15:29:57.818+00:00",
    "identifier": [
        {
            "system": "http://HopsitalX.org/LIS",
            "value": "543XCB_HospitalLab",
        }
    ],
    "name": "HospitalX-Lab"
}

检测类型（PCR、RNA、抗体等）由 Observation.code 元素中的 LOINC 代码定义。您在问题中放置的代码 sn-p 是 ValueSet 资源的一个实例，它定义了一组为 SARS CoV 2 测试创建的 LOINC 代码。它既可用作知识资源（帮助您了解 SARS CoV 2 的 LOINC 代码），也可用作验证工具（帮助您确定 Observation 实例是否是 SARS CoV 2 LOINC 测试之一）。

【讨论】：