Pathology standards and implementation

NHS England’s Pathology Standards Programme are delivering the ability to share pathology laboratory test results across the NHS.

Using SNOMED CT and FHIR, we have created 2 key data products to support pathology reporting and defined the information standard that governs their use.

To help providers and system suppliers integrate our data products and reach conformance with DAPB4101, we are working together with NHS England’s Diagnostics Digital Capability Programme and Digital Primary Care Programme towards creating an implementation strategy, guidance, and roadmap for national adoption; our role being to provide informatic support.

In the pathology report sent from laboratories to primary care, DAPB 4101 governs the use of SNOMED CT Observable entity concepts to represent specific* pathology laboratory test result codes, and SNOMED CT Procedure concepts to represent the specific laboratory test initially requested (including panels/batteries of tests). To support complex pathology reporting structures containing fully atomic, coded results, DAPB4101 mandates the use of pathology specific FHIR UK Core R4 profiles, the goal being the interoperable sharing of pathology reports for the purpose of direct care.

DAPB 4101 underpins the Pathology Messaging – FHIR integration, which will replace the Pathology Messaging - EDIFACT integration (PMIP EDIFACT).

PMIP EDIFACT is governed by the ISB 1557 EDIFACT Pathology Messaging Standard (Amd 39/2003 EDIFACT v1.003), scheduled for deprecation in April 2024.

Pathology laboratory test result codes account for approximately one third of all the clinical information recorded each year in primary care Electronic Patient Records.

Reference: Pathology networks - NHS England, SNOMED Code Usage in Primary Care – NHS England

Conformance with DAPB4101 integration will bring many benefits to patients, clinicians and commissioners of NHS pathology services. These include:

• the ability to code new pathology tests - new laboratory test result codes can be created using a standardised, interoperable terminology
• improved clinical safety - pathology results can be shared and accessed by clinicians across the NHS in a format that is clear and unambiguous
• improved data quality - standardised, semantically interoperable and unambiguous pathology result data that supports machine-readability will enable AI-aided analytics, research and clinical decision support
• reduction of costs - clear, unambiguous pathology reporting will reduce the need for duplicate testing by clinicians and enable providers to review commissioning costs
• adoption of modern, internationally recognised standards SNOMED CT and FHIR will replace the outdated, localised, non-maintainable suite of data products, future-proofing the interoperable flow of pathology reports

DAPB 4101 has been designed to replace the PMIP EDIFACT integration with the Pathology Messaging - FHIR integration.

PMIP EDIFACT is fundamentally limited because:

• it is unable to carry SNOMED CT test result concepts - it can only support Read v2 PBCL codes
• it is unable to support complex report structures containing fully atomic, coded results – data elements are mainly represented as text
• the continued use of PMIP EDIFACT is a significant barrier to new market entrants who struggle to implement a messaging technology that is over 30 years old, and not aligned with modern standards such as FHIR

Read v2 was retired in April 2016 and it is no longer possible to create new national Read codes. Since 2018, all NHS healthcare providers in England have been required to use SNOMED CT for all data transfer of clinical information into electronic patient record systems, as per the SCCI0034: SNOMED CT Information Standards Notice. Adherence to SCCI0034: SNOMED CT is now fully mandated under the Care Act, following amendments made in 2022/23.

This replacement is also a professional requirement supported by members of the Royal College of GPs and the Royal College of Pathologists.

To achieve these aims, we are:

1. Publishing SNOMED CT content for pathology reporting.
2. Publishing FHIR UK Core R4 profiles for pathology reporting.
3. Publishing the DAPB4101 Pathology and Laboratory Medicine Reporting Information Standard, implementation guidance, and requirements specification.
4. Providing informatic support to providers, pathology LIMS and middleware suppliers, and GP system suppliers to integrate our data products.
5. Supporting a LIMS - GP data flow pilot to establish and prove how a FHIR/SNOMED pathology report can be safely sent and ingested.
6. Working with aligned NHS Programmes towards national adoption of FHIR/SNOMED pathology reporting.
7. Establishing best practice for laboratories to map legacy lab-specific request and result codes to SNOMED CT using NHS England Terminology Server.