Accession: "An increase by means of something added to record as acquired" - Websters. Accessioning is the act of taking on the responsibility to perform a laboratory test and adding the test to the laboratory's workload (hence the word accession, the workload or responsibility has been increased). While the definition would imply a close alignment with the Lab Test Promise, in practice, the Accession (and the "Accession Number") are more closely associated with the Specimen, as the Specimen represents a unit of work. Accession numbers and specimen numbers are often related, and when a specimen is subsetted for some other purpose, a new accession number may be created. This class represents the act of creating a new accession, and is associated with both the Promise and the Specimen.

This class contains measurements of various organs and structures to include the entire body. The bodySite property indicates the organ or structure to be measured, e.g., Brain. The measurementType indicates whether we're measuring the length, volume, or weight. The measurementValue property holds the actual measurement e.g., 1500 grams. In VA's VistA system, the following fields are specificaly called out, which would be contained in this class, along with potentially others: Body Height, Body Weight, Length Of Aortic Valve, Length Of Mitral Valve, Length Of Pulmonic Valve, Length Of Tricuspid Valve, Length Of Ventricle (Left), Length Of Ventricle (Right), Volume Of Pericardial Cavity, Volume Of Peritoneal Cavity, Volume Of Pleural Cavity (Left), Volume Of Pleural Cavity (Right), Weight Of Adrenal Gland (Left), Weight Of Adrenal Gland(Right), Weight Of Brain , Weight Of Heart , Weight Of Kidney (Left), Weight Of Kidney (Right), Weight Of Liver, Weight Of Lung (Left), Weight Of Lung (Right), Weight Of Ovary (Left), Weight Of Ovary (Right), Weight Of Pancreas, Weight Of Parathyroid (Left Lower), Weight Of Parathyroid (Left Upper), Weight Of Parathyroid (Right Lower), Weight Of Parathyroid (Right Upper), Weight Of Pituitary Gland, Weight Of Spleen, Weight Of Testis (Left), Weight Of Testis (Right), Weight Of Thyroid Gland

This class represents a drug challenge. A drug challenge tests the susceptibility of a culture of the identified organism to an antibiotic. Note that the determination whether a microbe is susceptible or resistant to the antibiotic would be reported in the interpretation class, which is inherited from the Reportable Result super type.

Contains all documentation produced as a result of the autopsy.

Clinical documents commonly have 'Subjective' and 'Objective' findings, both of which are kinds of Observations. In addition, clinical documents commonly contain 'Assessments', which are also kinds of Observations. Thus, the establishment of a diagnosis is an Observation.

The specific patient-related event to which a specimen collection or collections (and subsequently, any tests performed on that specimen) are related or affected by time, sequence, directive, intent, etc. Examples might include drug administration (peak and trough), beginning of fasting (lipids, FBS), glucose challenge (tolerances) or meal (postprandial), admission (pre- or post-admission studies), scheduled surgery/transfusion (compatibility testing), onset of symptoms (acute and convalescent), Last Menstrual Period (pregnancy test, Pap smear), lumbar puncture (CSF tubes 1, 2, and 3), treatment completion (test of cure, post-transfusion H&H), use/ingestion (BAT, toxicology), start of 24-hour urine pooling (creatinine clearance), etc.

This class represents a test result or observation that may be reported. Some tests, such as an microbiology identification may have multiple results reported over time, for example a preliminary gram stain result might be initially reported, followed by the identification and relative number of organisms, followed by an antibiotic senstivity test results. Each one of these results would manifest as a separate instance of this class, each with their own date/times, performers, etc. "The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report." - HL7 Version 2.8, OBX

An order placed by a laboratory to another laboratory to perform a test that the originating laboratory had taken on. This action typically occurs when the originating laboratory cannot perform the requested test in-house.

This class represents a section of a Pathology Report. Pathology results generally take the form of documents, which in turn are composed of sections containing free-form text. The College of American Pathologists lists a number of sections that a well-formed pathology report should or may contain. The Pathology Result class therefore is comprised of Lab Report Sections, the Section Title of which should come from some pre-defined vocabulary.

This class represents an intent to perform one or more Laboratory Tests in response to a Request (an Order) from an authorized entity (usually a doctor). A Promise is an intent to perform a service that has the strength of a commitment, i.e., other parties may rely on the originator of such promise that said originator will see to it that the promised act will be fulfilled. A promise can be either solicited or unsolicited. The entity that makes such a promise is also called a "filler", while the entity that requests the service is also called a "placer". The Laboratory Test Promise can be looked at as the Laboratory Test Order from the laboratory's point of view.

This class contains attributes associated with a record of the investigative procedure requested to be performed in the laboratory. Need to flesh out how to model both Panels and individual tests at the same time. It is not reasonable to expect to be able to standardize panels, but may have to enumerate the tests that make up the panel ordered.

An observation of the quantity of the analyte found within the sample. Note that loinc and procedure codes are identifying more specifically the type of test being performed. Because there may be multiple methodologies available to measure the same substance, these codes are more specific than the analyte and testCode referenced in the ChemistryTest class. Note that this class has 5 subtypes to handle the different kinds of result values. Most chemistry tests are physical quanties (e.g., mg/dL). Some are coded, and even those that normally are physical quantities might be replaced by a coded observation of Quantity Not Sufficient.

This class documents each Microbiology identification observation (note that in this case, "Microbiology" includes Bacteriology, Mycobacteriology, Mycology, Parasitology, and Virology).

This class represents findings, other than the identification of microorganisms, arrived at by microscopic observation of a specimen. This includes observations made of cells or tissue. For example, the detection of red blood cells in a urine sample would be reported via this class.

The organism identified as being present within a specimen sample. "Organism" as used here is not the full spectrum of possible living things, but rather is limited to a member of the following: Bacteria, Fungus, Mycobacterium, Parasite, or Virus. Note that some organisms, primarily parasites, may undergo different stages over their lifetime (e.g., eggs, larvae, adults), which is indicated in the optional lifeStage property. Some terminologies will pre-coordinate the organismTaxon and stage into a single code (Giardia lamblia cysts, Giardia lamblia trophozoites).

This class documents the results of a Pathology observation event. Note that the VA makes a distinction between AnatomicalPathology, Cytopathology, ElectronMicroscopy, and SurgicalPathology, all of which are handled by this one class. Also, a large portion of Autopy observations take the form of pathology reports. Pathology results generally take the form of documents, which in turn are composed of sections containing free-form text. The College of American Pathologists lists a number of sections that a well-formed pathology report should or may contain. The Pathology Result class therefore is comprised of Lab Report Sections, the Section Title of which should come from some pre-defined vocabulary. The report may also contain images and diagnoses. It is noted that this entire structure could easily be replaced by a Clinical Document; in the future we may point to Clinical Document rather than maintain a separate Pathology Result structure.

This class identifies any substances that were added or introduced to the specimen in order to preserve, maintain or enhance the particular nature or component of the specimen. While the HL7 definition implies that this additive is only used before or during specimen collection, this Additive class may be used after specimen collection as part of specimen processing as well.

This class contains observations regarding the Specimen. Such observations, or assessments, of the Specimen are performed by the laboratory upon initial receipt, although periodic assessments may be performed later, especially when the Specimen is in long-term storage, or when some change in custody has occurred. The assessment also contains information concerning the handling of the Specimen, such as storage or transportation information.

The actual gathering of portions or quantities of material for use in testing, examination, or study based upon the request (order).

This class represents an intent to collect one or more Specimens in response to a Request (an Order) from an authorized entity (usually a doctor). A Promise is an intent to perform a service that has the strength of a commitment, i.e., other parties may rely on the originator of such promise that said originator will see to it that the promised act will be fulfilled. A promise can be either solicited or unsolicited. The entity that makes such a promise is also called a "filler", while the entity that requests the service is also called a "placer". The Specimen Collection Promise can be looked at as the Specimen Collection Order from the point of view of the entity collecting the Specimen. It should be noted that while a Specimen Collection Promise logically occurs in response to an order, the notion of a Specimen Collection Promise is rarely implemented as separate concept, because specimen collections typically occur automatically based on policy, procedure, or contract. Rarely would two computers be exchanging messages requesting and acknowledging specimen collections; most likely this would occur when a patient is sent to the laboratory for specimen collection. Nevertheless, the class exists in order to support the few cases where an explicit promise is needed.

The gathering of portions or quantities of material for use in testing, examination, or study based upon a request (order). For example, a blood or urine sample. "Details concerning a test or procedure request that required a specimen to be collected." - HL7 FHIR, Specimen.request

Container: "an object used for or capable of holding, esp for transport or storage, such as a carton, box, etc." - Dictionary.com. This class describes the object in which the specimen is contained, such as its capacity, etc. Some containers are manufactured such that they contain a pre-defined substance that may act to preserve, maintain or enhance the particular nature or component of the specimen. For example, a "blue top tube" typically contains an anticoagulant such as citrate. It is therefore important to know what kind of container the sample is in, as the condition of the sample may be affected. "An Entity that holds other Entities." - HL7 Version 3. "The container holding the specimen. The recursive nature of containers; i.e. blood in tube in tray in rack is not addressed here." - HL7 FHIR, Specimen.container

This class contains information regarding the transportation or storage of a specimen. Information may be recorded for both storage and transportation about the minimum and maximum temperatures to which the specimen was exposed. Subtypes of this class deal with specific requirements for storage and transportation. Note that we need to model more details regarding chain of custody in general and the storage and handling of specimens in specific in future modeling iterations. We may also need a shipping-container assessment, not just specimen assessment.

This class represents actions performed on a specimen in order to prepare it for future testing. Such actions may include adding an additive or placing the specimen in a container containing a pre-defined additive in order to preserve, maintain or enhance the particular nature or component of the specimen. Other actions include aliquoting a single specimens into multiple subsets, grouping or pooling multiple specimens into one specimen, etc. As a result of this processing event, a new specimen(s) may be created, thus this class contains a pointer (zero-to-many) back to the Specimen class to identify the newly-created Specimen(s). "Details concerning processing and processing steps for the specimen." - HL7 FHIR, Specimen.processing

This class contains information regarding the storage of a specimen. This class currently contains a storage location identifier, but will be augmented in future iterations as we intend to model more details regarding chain of custody as well as long-term storage (for example tissue banks).

This class contains information regarding the transportation of a specimen. This class currently contains the shipment identifier and the method of transportation, but will be augmented in future iterations as we intend to model more details regarding chain of custody.