LaboratoryOrder

A request for laboratory diagnostic tests to be performed on a patient specimen. Tracks ordering information including test specifications, clinical indications, priority levels, and performing laboratory designation.

Overview

LaboratoryOrder captures the clinical request for laboratory testing. It links the ordering provider to the requested test, documents the clinical indication (why the test is needed), specifies urgency, and designates the performing laboratory. Orders progress through a lifecycle from draft through completion, with specimen collection and result generation tracked through related entities.

Key Concepts

Order Status

The status field tracks order lifecycle:

StatusDescriptionNext Steps
draftBeing composedComplete and activate
activeReady for collectionCollect specimen
on-holdTemporarily pausedResolve issue
completedResults receivedReview results
revokedCancelledDocument reason
entered-in-errorInvalidDisregard

Order Intent

The intent field clarifies the order purpose:

IntentDescriptionAuthorization Level
orderActionable requestProvider signed
original-orderFirst orderProvider signed
reflex-orderAuto-generatedLab protocol
filler-orderLab-initiatedLab discretion
proposalRecommendationNeeds approval
planFuture intentNot yet actionable

Priority Levels

The priority field drives processing speed:

PriorityTurnaroundScenario
routineStandardWellness screening
urgentSame dayAcute concern
asapHoursDeteriorating patient
statImmediateEmergency/critical

Clinical Indication

Why the test is ordered:

  • reasonCode - ICD-10/SNOMED coded diagnoses
  • reasonText - Free-text clinical context
  • Supports medical necessity
  • Required for insurance authorization

Test Specification

The code field references LabTest:

  • LOINC-coded test definition
  • Includes specimen requirements
  • Links to reference ranges
  • Supports order validation

Ordering Provider

The orderingPractitioner links to Practitioner:

  • Establishes order authority
  • Contact for critical results
  • Responsible for follow-up
  • Compliance accountability

Performing Laboratory

The performerLab links to Facility:

  • Designated testing laboratory
  • May be internal or reference lab
  • Determines routing
  • Affects turnaround time

Scheduling

The scheduledDateTime field:

  • When specimen should be collected
  • Supports fasting requirements
  • Enables patient preparation
  • Coordinates with appointments

Use Cases

Routine Lab Order

For standard testing:

  1. Create order with intent: "order"
  2. Select test from catalog
  3. Document clinical indication
  4. Set priority: "routine"
  5. Assign to performing lab
  6. Activate order

STAT Order

For emergencies:

  1. Create order with priority: "stat"
  2. Document urgent indication
  3. Notify laboratory
  4. Expedite specimen collection
  5. Monitor for rapid results
  6. Follow critical value protocol

Pre-Operative Labs

For surgical clearance:

  1. Order required panel
  2. Schedule collection before surgery
  3. Route to rapid-result lab
  4. Track completion status
  5. Alert if not resulted in time

Reflex Testing

For protocol-based add-ons:

  1. Lab creates reflex-order
  2. Links to original order
  3. Documents reflex criteria
  4. No additional provider action
  5. Results reported together

Order Cancellation

When order no longer needed:

  1. Update status: "revoked"
  2. Document cancellation reason
  3. Notify laboratory
  4. Stop specimen collection
  5. Update patient

Related Entities

EntityRelationshipDescription
PatientReferencesWho the test is for
EncounterReferencesVisit context
LabTestReferencesTest being ordered
PractitionerReferencesOrdering provider
FacilityReferencesPerforming laboratory
SpecimenHas manyCollected specimens
CodingContainsReason codes
ClinicalIdentifierContainsOrder identifiers
LaboratoryResultReferenced byTest results

Calculated Fields

FieldTypeDescription
isActivebooleanTrue when status is active
isPendingbooleanTrue when not completed, revoked, or error

Enums

status

ValueDescription
draftOrder is being composed but not yet finalized
activeOrder is active and awaiting specimen collection or processing
on-holdOrder temporarily paused pending resolution of an issue
revokedOrder has been cancelled and should not be performed
completedOrder has been fulfilled and results are available
entered-in-errorOrder was created in error and should be disregarded
unknownOrder status cannot be determined

intent

ValueDescription
proposalSuggestion for ordering provider consideration
planIntended future order, not yet actionable
directiveAuthoritative instruction requiring action
orderActionable request authorized by provider
original-orderFirst order for this test
reflex-orderAuto-generated based on previous result or protocol
filler-orderCreated by laboratory based on clinical need
instance-orderSingle instance of a standing order

priority

ValueDescription
routineStandard processing with normal turnaround time
urgentSame-day processing required
asapProcess as soon as possible, within hours
statImmediate processing required for emergency situations
17 properties
Schema

Properties

PropertyTypeModeDescriptionRequired
identifierClinicalIdentifier[]
stored

Unique business identifiers assigned to this laboratory order by healthcare facilities, laboratory information systems, or electronic health record systems for tracking and reference purposes across multiple systems and organizations

Example: [{"@type":"ClinicalIdentifier","value":"LAB-ORD-2024-123456","clinicalSystem":"custom"}]

Optional
patientPatient
stored

Reference to the patient for whom the laboratory tests are being ordered and from whom specimens will be collected

Required
encounterEncounter
stored

Reference to the healthcare encounter during which this laboratory order was created, linking the order to the specific clinical context and visit

Example: {"@type":"Encounter","identifier":[{"@type":"ClinicalIdentifier","value":"ENC-2024-789012"}]}

Optional
statusstring
stored

Current state of the laboratory order in its lifecycle from initial creation through completion or cancellation, tracking order progression through the diagnostic workflow

Values: draft, active, on-hold, revoked, completed, entered-in-error, unknown

Example: "active"

Required
intentstring
stored

Indicates the level of authority and purpose of the order request, distinguishing between proposals, planned orders, and definitive instructions for laboratory test execution

Values: proposal, plan, directive, order, original-order, reflex-order, filler-order, instance-order

Example: "order"

Required
prioritystring
stored

Urgency level of the laboratory order that drives specimen processing priority, turnaround time expectations, and resource allocation in the laboratory workflow

Values: routine, urgent, asap, stat

Example: "routine"

Required
codeLabTest
stored

Reference to the standardized laboratory test being ordered, specifying the exact diagnostic procedure to be performed with LOINC or other standard coding

Example: {"@type":"LabTest","code":"58410-2","system":"LOINC","label":"Complete blood count (CBC) panel - Blood by Automated count","shortName":"CBC","category":"hematology"}

Required
orderingPractitionerPractitioner
stored

Reference to the healthcare practitioner who authorized and placed the laboratory order, establishing clinical responsibility and providing contact for result reporting

Example: {"@type":"Practitioner","givenName":"Sarah","familyName":"Johnson","licenseNumber":"MD-CA-456789"}

Required
authoredOnDateTime
stored

Date and time when the laboratory order was originally created and authorized by the ordering practitioner, establishing the order timestamp for workflow tracking

Example: "2024-11-30T09:15:00Z"

Required
reasonCodeCoding[]
stored

Coded clinical reasons, diagnoses, or conditions that justify the laboratory test order, supporting appropriate utilization, insurance authorization, and quality measurement using standardized medical terminology

Example: [{"@type":"Coding","code":"25374005","system":"SNOMED-CT","display":"Gastroenteritis"}]

Optional
reasonTextstring
stored

Free-text narrative description of the clinical indication for ordering the laboratory test, capturing specific symptoms, clinical concerns, or monitoring needs that may not be fully represented by coded values

Example: "Rule out bacterial infection - patient with persistent fever and elevated white blood cell count"

Optional
specimenSpecimen[]
stored

Specification of the biological specimen type and collection requirements for the ordered laboratory test, providing guidance for specimen collection, handling, and processing

Optional
performerLabFacility
stored

Reference to the specific laboratory facility or organization designated to perform the ordered test, enabling proper order routing and result reporting

Example: {"@type":"Facility","name":"City General Hospital Clinical Laboratory"}

Optional
notestring
stored

Additional instructions, special handling requirements, or clinical context information for laboratory staff performing the test, ensuring proper test execution and result interpretation

Example: "Patient is on anticoagulation therapy - handle specimen carefully"

Optional
scheduledDateTimeDateTime
stored

Planned date and time when the specimen should be collected or the laboratory test should be performed, supporting workflow scheduling and patient preparation

Example: "2024-11-30T10:00:00Z"

Optional
isActiveboolean
calculated

Whether the laboratory order is currently active and awaiting completion - true when status is active, indicating the order is valid and pending execution or in progress

Optional
isPendingboolean
calculated

Whether the laboratory order has not yet been completed - true when status is not completed, revoked, or entered-in-error, indicating ongoing order lifecycle requiring action or monitoring

Optional

Examples

Example 1

{
  "@type": "LaboratoryOrder",
  "identifier": [
    {
      "@type": "ClinicalIdentifier",
      "value": "LAB-ORD-2024-001234",
      "clinicalSystem": "custom",
      "assigner": {
        "@type": "Organization",
        "name": "City General Hospital"
      }
    }
  ],
  "patient": {
    "@type": "Patient",
    "givenName": "John",
    "familyName": "Smith",
    "birthDate": "1975-05-15"
  },
  "encounter": {
    "@type": "Encounter",
    "identifier": [
      {
        "@type": "ClinicalIdentifier",
        "value": "ENC-2024-445566"
      }
    ]
  },
  "status": "active",
  "intent": "order",
  "priority": "routine",
  "code": {
    "@type": "LabTest",
    "code": "58410-2",
    "system": "LOINC",
    "label": "Complete blood count (CBC) panel - Blood by Automated count",
    "shortName": "CBC",
    "category": "hematology",
    "specimenType": "Blood"
  },
  "orderingPractitioner": {
    "@type": "Practitioner",
    "givenName": "Sarah",
    "familyName": "Johnson",
    "licenseNumber": "MD-CA-456789"
  },
  "authoredOn": "2024-11-30T09:15:00Z",
  "reasonCode": [
    {
      "@type": "Coding",
      "code": "271807003",
      "system": "SNOMED-CT",
      "display": "Eruption of skin"
    }
  ],
  "reasonText": "Annual wellness exam - routine health screening",
  "performerLab": {
    "@type": "Facility",
    "name": "City General Hospital Clinical Laboratory"
  },
  "scheduledDateTime": "2024-11-30T10:00:00Z",
  "_comment": "isActive: true, isPending: true"
}

Example 2

{
  "@type": "LaboratoryOrder",
  "identifier": [
    {
      "@type": "ClinicalIdentifier",
      "value": "LAB-ORD-2024-002456",
      "clinicalSystem": "custom",
      "assigner": {
        "@type": "Organization",
        "name": "Downtown Medical Center"
      }
    }
  ],
  "patient": {
    "@type": "Patient",
    "givenName": "Maria",
    "familyName": "Garcia",
    "birthDate": "1989-03-22"
  },
  "encounter": {
    "@type": "Encounter",
    "identifier": [
      {
        "@type": "ClinicalIdentifier",
        "value": "ENC-2024-778899"
      }
    ]
  },
  "status": "active",
  "intent": "order",
  "priority": "urgent",
  "code": {
    "@type": "LabTest",
    "code": "24323-8",
    "system": "LOINC",
    "label": "Comprehensive metabolic panel - Serum or Plasma",
    "shortName": "CMP",
    "category": "chemistry",
    "specimenType": "Blood"
  },
  "orderingPractitioner": {
    "@type": "Practitioner",
    "givenName": "Michael",
    "familyName": "Chen",
    "licenseNumber": "MD-CA-789012"
  },
  "authoredOn": "2024-11-30T14:20:00Z",
  "reasonCode": [
    {
      "@type": "Coding",
      "code": "84229001",
      "system": "SNOMED-CT",
      "display": "Fatigue"
    },
    {
      "@type": "Coding",
      "code": "161873000",
      "system": "SNOMED-CT",
      "display": "Heavy drinker"
    }
  ],
  "reasonText": "Patient presenting with fatigue and electrolyte imbalance concerns - recent dehydration episode",
  "performerLab": {
    "@type": "Facility",
    "name": "Regional Reference Laboratory"
  },
  "note": "Priority processing requested - patient scheduled for surgery tomorrow",
  "scheduledDateTime": "2024-11-30T15:00:00Z",
  "_comment": "isActive: true, isPending: true"
}

Example 3

{
  "@type": "LaboratoryOrder",
  "identifier": [
    {
      "@type": "ClinicalIdentifier",
      "value": "LAB-ORD-2024-003789",
      "clinicalSystem": "custom",
      "assigner": {
        "@type": "Organization",
        "name": "Emergency Department - City Hospital"
      }
    }
  ],
  "patient": {
    "@type": "Patient",
    "givenName": "Robert",
    "familyName": "Williams",
    "birthDate": "1962-08-10"
  },
  "encounter": {
    "@type": "Encounter",
    "identifier": [
      {
        "@type": "ClinicalIdentifier",
        "value": "ER-2024-990011"
      }
    ]
  },
  "status": "active",
  "intent": "order",
  "priority": "stat",
  "code": {
    "@type": "LabTest",
    "code": "600-7",
    "system": "LOINC",
    "label": "Bacteria identified in Blood by Culture",
    "shortName": "Blood Culture",
    "category": "microbiology",
    "specimenType": "Blood"
  },
  "orderingPractitioner": {
    "@type": "Practitioner",
    "givenName": "David",
    "familyName": "Martinez",
    "licenseNumber": "MD-CA-345678"
  },
  "authoredOn": "2024-11-30T18:45:00Z",
  "reasonCode": [
    {
      "@type": "Coding",
      "code": "266919005",
      "system": "SNOMED-CT",
      "display": "Septicemia"
    }
  ],
  "reasonText": "Suspected sepsis - patient with fever 39.5°C, hypotension, and elevated lactate",
  "performerLab": {
    "@type": "Facility",
    "name": "City Hospital Microbiology Laboratory"
  },
  "note": "STAT - Suspected sepsis protocol activated. Collect before antibiotic administration. Maintain strict aseptic technique.",
  "scheduledDateTime": "2024-11-30T18:50:00Z",
  "_comment": "isActive: true, isPending: true"
}