Pathology FHIR specification

Fast Healthcare Interoperability Resources (FHIR) is a standards framework that is used for healthcare data exchange. In this context, it is used to define the structure of pathology and laboratory medicine test reports.

In the pathology laboratory to GP practice data flow, test reports are currently represented using the data structure defined in the PMIP EDIFACT (NHS003) specification. As described in the DAPB4101 Pathology and Laboratory Medicine Reporting Information Standard, PMIP EDIFACT (NHS003) will be replaced by a specification based on FHIR. Each pathology report will be represented by a FHIR UK Core R4 ‘bundle’ and will include:

• SNOMED CT Observable entity concepts to represent the laboratory test result code
• SNOMED CT Procedure concepts to represent test panels/batteries within the test report
• SNOMED CT Procedure concepts to represent the specific laboratory test initially requested

Download a diagram that illustrates the structure of an example HbA1c and serum lipid level laboratory test report

NHS England has created pathology-specific FHIR UK Core R4 profiles and an accompanying implementation guide:

The Pathology FHIR implementation guide provides the detailed guidance system suppliers will need to implement the pathology-related FHIR profiles. Regularly updated, this FHIR implementation guide is referenced in DAPB4101’s implementation guidance as the source of truth for implementors.

NHS England's Message Exchange for Social Care and Health (MESH) service is currently used to transport PMIP EDIFACT pathology reports from laboratory systems to GP systems.

In addition to MESH, FHIR supports other methods of exchanging data, including the use of RESTful APIs. These will be used to transport DAPB4101 pathology reports.

NHS England is developing new architecture designed to replace MESH that will enable the interoperable flow of diagnostic data across the estate.

To support DAPB4101, the proposed solution involves:

• laboratory information management systems to create pathology and laboratory medicine reports in various formats
• pathology middleware to transform these into FHIR/SNOMED reports
• sending reports to the 'Pathology API', a RESTful interface serving as a gateway for diagnostic data
• the Pathology API linking to the Patient Data Manager which will validate the reports against the Pathology FHIR Specification
• the Pathology API then publishing the messages to the Multicast Notification Service, in turn delivering them to GP systems
• a synchronous integration, with acknowledgements flowing accordingly
• a platinum service
• alpha/beta testing to test and assure the solution and establish the onboarding process for suppliers