Not getting expected search results from SmartHealthIt FHIR server for DiagnosticReport searching
I'm trying to find a patient with a DiagnosticReport using the SmartHealthIt FHIR server at https://r4.smarthealthit.org.
Queries are based on the guide at https://www.hl7.org/fhir/search.html.
If I execute the following query I get the following result that includes a patient with the id 87a339d0-8cae-418e-89c7-8651e6aab3c6.
Query: https://r4.smarthealthit.org/Patient?_type=DiagnosticReport&_summary=true
Result:
If I then query for the DiagnosticReport resources for this patient and try to filer for just the DiagnosticReport resources, I get a result that does not include any DiagnosticReport resources as shown below. Likewise, if I just retrieve the patient using https://r4.smarthealthit.org/Patient/87a339d0-8cae-418e-89c7-8651e6aab3c6, I get a response that does not include the text "DiagnosticReport" or "next" (in case the resource was paged).
How do I find the set of patients that have a DiagnosticReport on a FHIR server?
Query:
https://r4.smarthealthit.org/Patient/87a339d0-8cae-418e-89c7-8651e6aab3c6?_elements=DiagnosticReport
Result:
{
"resourceType": "Patient",
"id": "87a339d0-8cae-418e-89c7-8651e6aab3c6",
"meta": {
"versionId": "227",
"lastUpdated": "2022-07-22T03:04:04.165-04:00",
"tag": [
{
"system": "https://smarthealthit.org/tags",
"code": "synthea-5-2019"
}
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated by <a href=\"https://github.com/synthetichealth/synthea\">Synthea</a>.Version identifier: v2.4.0-100-g26a4b936\n . Person seed: 911708758626700213 Population seed: 1559319163074</div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "text",
"valueString": "White"
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
}
},
{
"url": "text",
"valueString": "Not Hispanic or Latino"
}
]
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
"valueString": "Vonnie Kunde"
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "F"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
"valueAddress": {
"city": "Milton",
"state": "Massachusetts",
"country": "US"
}
},
{
"url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
"valueDecimal": 26.256072397468692
},
{
"url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
"valueDecimal": 29.743927602531308
}
],
"identifier": [
{
"system": "https://github.com/synthetichealth/synthea",
"value": "293ee354-f8ad-4345-b10c-759fdfdcc082"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}
],
"text": "Medical Record Number"
},
"system": "http://hospital.smarthealthit.org",
"value": "293ee354-f8ad-4345-b10c-759fdfdcc082"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "SS",
"display": "Social Security Number"
}
],
"text": "Social Security Number"
},
"system": "http://hl7.org/fhir/sid/us-ssn",
"value": "999-97-9098"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "DL",
"display": "Driver's License"
}
],
"text": "Driver's License"
},
"system": "urn:oid:2.16.840.1.113883.4.3.25",
"value": "S99981121"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PPN",
"display": "Passport Number"
}
],
"text": "Passport Number"
},
"system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
"value": "X1974835X"
}
],
"name": [
{
"use": "official",
"family": "Kshlerin",
"given": [
"Danae"
],
"prefix": [
"Mrs."
]
},
{
"use": "maiden",
"family": "Graham",
"given": [
"Danae"
],
"prefix": [
"Mrs."
]
}
],
"telecom": [
{
"system": "phone",
"value": "555-182-4285",
"use": "home"
}
],
"gender": "female",
"birthDate": "1964-05-13",
"address": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/geolocation",
"extension": [
{
"url": "latitude",
"valueDecimal": 42.50128
},
{
"url": "longitude",
"valueDecimal": -70.897502
}
]
}
],
"line": [
"662 Ullrich Path Suite 61"
],
"city": "Salem",
"state": "Massachusetts",
"postalCode": "01907",
"country": "US"
}
],
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M",
"display": "M"
}
],
"text": "M"
},
"multipleBirthBoolean": false,
"communication": [
{
"language": {
"coding": [
{
"system": "urn:ietf:bcp:47",
"code": "en-US",
"display": "English"
}
],
"text": "English"
}
}
]
}
---EDIT-----------------------
I'm not seeing the patient id I originally used as an example now (the data could be paged and the order not consistent so it might be on a subsequent page).
This patient ID is coming up and gives the same behavior: 87a339d0-8cae-418e-89c7-8651e6aab3c6
The following query sometimes (often) includes the patient 87a339d0-8cae-418e-89c7-8651e6aab3c6:
https://r4.smarthealthit.org/Patient?_type=DiagnosticReport&_summary=true
The following query response contains neither the text "diag" nor "next"
https://r4.smarthealthit.org/Patient/87a339d0-8cae-418e-89c7-8651e6aab3c6?_elements=DiagnosticReport
The following query response contains neither the text "diag" nor "next"
https://r4.smarthealthit.org/Patient/87a339d0-8cae-418e-89c7-8651e6aab3c6
--- SECOND EDIT -------------------------
Not finding the DiagnosticReport in the Patient resource was just me being forgetful. You need to use the $everything locator as in:
https://r4.smarthealthit.org/Patient/87a339d0-8cae-418e-89c7-8651e6aab3c6/$everything
This does contain a "next" link.
I haven't yet confirmed that you eventually get to the DianosticReport resources using the next links (it seems to time out for the link below).
---THIRD EDIT --------------------------------
This patient can be used to confirm a patient with a DiagnosticReport exists:
d78af07c-9cb9-4f31-9b11-c45a28f2eec8
This url gives the first page of the patient that has a next link: https://r4.smarthealthit.org/Patient/d78af07c-9cb9-4f31-9b11-c45a28f2eec8/$everything
This is the next link that gives the DiagnosticReport:
Here is a DiagnosticReport from the response.
"resource": {
"resourceType": "DiagnosticReport",
"id": "ca42703d-054c-4fc5-aaa5-c9d4f9688e89",
"meta": {
"versionId": "4",
"lastUpdated": "2021-04-06T03:13:59.601-04:00",
"tag": [
{
"system": "https://smarthealthit.org/tags",
"code": "synthea-5-2019"
}
]
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "57698-3",
"display": "Lipid Panel"
}
],
"text": "Lipid Panel"
},
"subject": {
"reference": "Patient/d78af07c-9cb9-4f31-9b11-c45a28f2eec8"
},
"encounter": {
"reference": "Encounter/2e0cc97b-c879-4762-bb5c-7127e44d7daa"
},
"effectiveDateTime": "2018-09-17T15:29:24+00:00",
"issued": "2018-09-17T15:29:24.181+00:00",
"result": [
{
"reference": "Observation/b512ea5d-c4c2-49e4-9eb1-30b2579136c4",
"display": "Total Cholesterol"
},
{
"reference": "Observation/3acb284d-e861-4db2-bbbc-b1522129df3c",
"display": "Triglycerides"
},
{
"reference": "Observation/9d3359e5-58e7-4c3c-8cfd-8cb6397dbcf7",
"display": "Low Density Lipoprotein Cholesterol"
},
{
"reference": "Observation/a708a2a4-8d9a-4869-a432-c5f09a46e67f",
"display": "High Density Lipoprotein Cholesterol"
}
]
},
For a list of patients having a DiagnosticReport perhaps you could just get a list of all DiagnosticReports because this will contain the references to the patients for each of the DiagnosticReport found.
To do so you can use the query:
https://r4.smarthealthit.org/DiagnosticReport?_summary=true
In the resultset, you will see references to patients e.g.
"subject": {
"reference": "Patient/15661112-796c-460c-bf7a-6b297e33f113"
},
If you already knew the patient id e.g. 87a339d0-8cae-418e-89c7-8651e6aab3c6, you could just do:
https://r4.smarthealthit.org/DiagnosticReport?subject=87a339d0-8cae-418e-89c7-8651e6aab3c6
- RE: _type parameter
Just a note on what you tried so far, the query using _type parameters is not quite right because you use type when query against the base endpoint i.e. without specifying the any type, so:
Query: https://r4.smarthealthit.org/Patient?_type=DiagnosticReport&_summary=true
Should actually have been as below, without the Patient type in the query:
Query: https://r4.smarthealthit.org?_type=DiagnosticReport&_summary=true
Read more about the _type parameter here: https://www.hl7.org/fhir/search.html#_type
- RE: _elements parameter
Also, the _elements parameter is not meant for resources but for specifying base elements defined in the resource. Your query that has _elements=DiagnosticReport is not correct because the is no such element on the Patient resource, hence why you may be getting results that are not consistent.
Hope that helps?
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