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  1. FHIR Specification Feedback
  2. FHIR-40521

The CBC is incomplete and has a few results and not a Complete Blood Count. Please Fix.

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Core (FHIR)
    • current
    • Cross-Group Projects
    • CBC Example
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      Will update example to follow 58410-2 CBC panel - Blood by Automated count and reference all the required members using the Long Common Name.

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      Will update example to follow 58410-2 CBC panel - Blood by Automated count and reference all the required members using the Long Common Name.
    • Eric Haas / Linda Michaelsen : 14-0-0
    • Correction
    • Non-substantive

    Description

      What's listed in the US Core CBC Example is not a complete Complete Blood Count.  Rather 4 results (observations) from a CBC panel order are listed in a partial Diagnostic Report example.  

      You may wish to see the LOINC that would be used for the CBC ORDER/SERVICE REQUEST/PANEL for the CBC here:  https://loinc.org/58410-2/

      You'll notice, Neutrophils are not part of a CBC.  Yet they are displayed here as part of one.  Neutrophils are part of the differential that is performed with a CBC with Auto Differential.  See the LOINC for CBC with Auto Differential: https://loinc.org/57021-8

      Given this Example is referenced by mCode for cancer and the CBC and differential results are most important for clinical laboratory, pathology reports  for leukemias, etc., cancer, cancer reporting, precision medicine, etc.  it would be advisable to update this example to a CBC with Auto Differential to be most useful, clinical accurate and not misleading.  

      You may wish to reference a Real World Example from one of the major reference labs:  https://www.labcorp.com/tests/005009/complete-blood-count-cbc-with-differential

      Including kathy_walsh as she is at LabCorp and can provide more information, if needed.

      You'll note they name their CBC With Differential panel order as "Complete Blood Count (CBC) With Differential."  This performing lab's order name would be in the Service Request upon which "based upon" the Diagnostic Report originates.  There should be the "link" back to the Service Request test order name which would "group" all the results/observations in the Diagnostic Report accordingly.  This is missing in the example too.  You'll note the order LOINC is the same as above and mapped to their panel/order name that would be in Service Request.

      Further, see the performing laboratory Result Names for each Result/Observation that is also missing from the CBC example Diagnostic Report.  "Codes" are not results!  In fact, given these appear to be based upon the LOINC Short Name, as you may know LOINC is dynamic and descriptions may be updated with each release.  Furthermore, the LOINC User Guide indicates LOINC Short Names or  Long Names Should NOT be used in Display/Facing implementations or for the performing laboratory test order or result build names as done here. (This has been discussed at several LOINC meetings ~5 years ago if you wish to review the LOINC meeting archives.)  It is also does not reflect good terminology implementation practice/usage.  See the LabCorp CBC example, whereby they correctly show the performing laboratory's name for each result/observation, followed by the mapped LOINC code. 

       

      The LabCorp example also includes a Sample report whereby you easily find example result values, flags, units, reference ranges and other details necessary for a complete Diagnostic Report:  https://files.labcorp.com/testmenu-d8/sample_reports/005009.pdf  The LabCorp example also illustrates this is a reflexive example with a reflex order for immatures cells and results (and their LOINCs) as indicated.

      One other aspect that would make this example more aligned with real world testing, is the order# and result# as unique identifiers for the tests that are listed in the performing laboratory's compendium of tests and allow for better alignment with FHIR Service Catalog that would be utilized to instantiate an order culminating in a Diagnostic Report on a particular patient instance.

      Clinicians are expecting to receive complete CBC results for clinical care, cancer reporting, etc.   This example is referenced by a number of IGs, including mCode:  http://hl7.org/fhir/us/mcode/

       

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            apitkus Andrea Pitkus
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