In certain (non-ideal, but still possible) situations it is possible for the concept of a "result" to exist and be flagged as abnormal, but without any individual supporting specific observations (OBXs) to carry that flag in OBX-8.  As an example, consider a situation where a clinical user receives paper results from an outside lab which contain abnormal findings; the user may just create the "order" in their EMR and flag it as abnormal for others to see a visual indicator of that, but simply scan the paper results into their DMS without entering any observations/text/etc.

In this situation, there's no obvious OBX (or thinking FHIR terms, Observation, since the DiagnosticReport would only have a .presentedForm in this case) to send.

This is likely a situation we cannot represent appropriately in FHIR and CDA as well.  I propose a new field for OBR, as well as a new element for DiagnosticReport and something equivalent in CDA, to represent an overall result/report-level interpretation with a user-defined value set.