Laboratory reports from openEHR

The openehr and laboratory features map an openEHR laboratory report to the HL7 Europe Laboratory Report 2.0.0 document, and map a received laboratory report document into openEHR. Regulation (EU) 2025/327 names medical test results, laboratory results included, as a priority category in Art 14(1)(e).

The shipped mappings

The crate ships the FHIRconnect 1.0.0 projects it runs under mappings/ in its package, and eehrxf::mappings embeds them as text. MPD is the prescription and dispensation project. LABORATORY is the laboratory project over the published KDS_Laborbericht template, whose laboratory result, analyte and specimen archetypes are CKM’s. Mapping::compile_project compiles a project from its embedded text with no file written, and Project::write_to writes a project’s files where a system keeps its mappings, the paths Mapping::compile takes. FerroBRIDGE’s own round-trip tests read the same directories, so a system that depends on the published crate runs the files those tests prove.

LABORATORY compiles the report context. The composition context maps the same template, so a mapping compiles it on its own.

Mapping out of openEHR

Mapping::to_fhir_with maps a committed composition to a FHIR R4 collection Bundle: the report, its results and specimens, and one Provenance covering them. Document::with_mapped_report takes that Bundle into a laboratory report document: the report becomes the DiagnosticReport-eu-lab the Bundle-eu-lab holds beside its composition, the results, the specimens and the Provenance become entries, and the method answers the fullUrl of each result for the section that lists them. The document’s Composition is the system’s own, as for every form of the component; the caller chooses the section by the study type of the report, one of the LAB_SLOTS.

Each result is an Observation-resultslab-eu-lab, which requires an effective[x] and a performer. The result takes the time of its laboratory test result’s event. KDS_Laborbericht holds no party for the performing laboratory, so the mapping writes performer absent: a Reference carrying only the FHIR R4 data-absent-reason extension with the code unknown. The run declares that element as a loss in its OperationOutcome, so the gap stays visible. A template that carries the performing laboratory as a party would let the mapping write the real performer and remove the absent one.

Receiving a laboratory report

ReceivedDocument::category names a document whose Composition.type carries LOINC 11502-2 a laboratory report. Composition-eu-lab binds Composition.type to the lab-reportType-eu-lab value set, which holds that one code. Category::profiles then names Bundle-eu-lab and Composition-eu-lab, which ReceivedDocument::check holds the document to. Mapping::to_openehr maps the document’s report into one KDS_Laborbericht composition and keeps the document as received in the composition’s FEEDER_AUDIT.original_content.

KDS_Laborbericht holds one report identifier. A report in a Bundle-eu-lab carries its own identifier and the document’s (dr-comp-identifier), so the run keeps one, declares the other lost in the composition’s OperationOutcome, and the original document still holds both.

A result’s reference range maps into the normal_range of its quantity, both bounds with their units, and back out as referenceRange. The range mapping is appended under analyteMeasurement, the mapping that writes the analyte value. KDS_Laborbericht allows any number of analyte clusters and exactly one value element items[at0001] in each, and analyteMeasurement writes that DV_QUANTITY whole, so the bounds merge into it as its children. A mapping of its own onto items[at0001] would write a second value with no magnitude, which the reference model refuses. R4 reads a range with no type as the normal range, so such a range maps to normal_range. A range with a type, such as a treatment range, maps to one element of the quantity’s other_reference_ranges: its type is the element’s meaning, and its low and high the bounds of the element’s range. Served out of openEHR, each element of other_reference_ranges comes back as a referenceRange with that type, after the normal range, in the order the composition holds them. The order a report answers maps by its identifier into the template’s test request details (protocol[at0004]/items[at0094]/items[at0063]), which KDS_Laborbericht annotates with DiagnosticReport.basedOn, and comes back as a Reference to a ServiceRequest.

The laboratory project accounts for DiagnosticReport.basedOn, Observation.basedOn and Observation.referenceRange (LABORATORY.accounted()). Each received instance of one that the run carries into no structured element is a warning issue in the composition’s OperationOutcome, its expression the element’s path: a range’s text, the order a result answers, or an order named by reference alone. The original document still holds them.