Presence absence example

This is an example FHIR R4 resource Bundle for reporting the presence/absence of influenza virus. Using FHIR provides a well-documented structure and semantics for representing this information, but for the actual exchange we don't plan to implement the FHIR RESTful API. Instead, bundle documents like these will be POSTed to a custom API endpoint.

When creating each Bundle:

• Generate a new UUID v4 for the id. This will help us identify specific bundles when troubleshooting. Another kind of id can be used instead of UUIDs, as long as it's robustly unique and it can be used to link back to your original records.

• Use the current ISO 8601 timestamp for timestamp.

For each DiagnosticReport entry in the Bundle:

• Generate a new UUID v4 for the id. This will help us identify specific reports (e.g. self-tests with your kit) when troubleshooting.

• Use the ISO 8601 timestamp of when the self-test was performed for effectiveDateTime.

• Use the actual specimen barcode scanned/input for the Specimen reference's seattleflu.org identifier value.

• Include a resource reference for every individual observation in result. These references refer to contained resources in contained.

For each Observation entry contained in the DiagnosticReport:

• Use the appropriate SNOMED CT clinical finding concept or LOINC concept for code. I've chosen two SNOMED CT concepts as examples which seem appropriate, but there are many options and others may be more precise.

• Use the actual boolean test result for valueBoolean. If three-valued logic is more appropriate (to include indeterminate results), this field can switch to valueConceptCode.

• Use Device reference as shown in example so that we can differentiate diagnostic results of different sources.

There is some room for structuring these results differently, particularly around how the results are represented with SNOMED CT / LOINC codes. The FHIR spec contains useful discussion and guidance for different patterns of observation representation.

A Bundle may contain more than one DiagnosticReport if you wish you send multiple results simultaneously. Sending one at a time is also ok.

There is also room to include additional information about the participant, their performance of the self-test, or the self-test kit/device itself via included Patient and Encounter. I omitted these as I'm not clear on what data might be useful or what you might want to include.