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:
| Status | Description | Next Steps |
|---|---|---|
draft | Being composed | Complete and activate |
active | Ready for collection | Collect specimen |
on-hold | Temporarily paused | Resolve issue |
completed | Results received | Review results |
revoked | Cancelled | Document reason |
entered-in-error | Invalid | Disregard |
Order Intent
The intent field clarifies the order purpose:
| Intent | Description | Authorization Level |
|---|---|---|
order | Actionable request | Provider signed |
original-order | First order | Provider signed |
reflex-order | Auto-generated | Lab protocol |
filler-order | Lab-initiated | Lab discretion |
proposal | Recommendation | Needs approval |
plan | Future intent | Not yet actionable |
Priority Levels
The priority field drives processing speed:
| Priority | Turnaround | Scenario |
|---|---|---|
routine | Standard | Wellness screening |
urgent | Same day | Acute concern |
asap | Hours | Deteriorating patient |
stat | Immediate | Emergency/critical |
Clinical Indication
Why the test is ordered:
reasonCode- ICD-10/SNOMED coded diagnosesreasonText- 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:
- Create order with
intent: "order" - Select test from catalog
- Document clinical indication
- Set
priority: "routine" - Assign to performing lab
- Activate order
STAT Order
For emergencies:
- Create order with
priority: "stat" - Document urgent indication
- Notify laboratory
- Expedite specimen collection
- Monitor for rapid results
- Follow critical value protocol
Pre-Operative Labs
For surgical clearance:
- Order required panel
- Schedule collection before surgery
- Route to rapid-result lab
- Track completion status
- Alert if not resulted in time
Reflex Testing
For protocol-based add-ons:
- Lab creates
reflex-order - Links to original order
- Documents reflex criteria
- No additional provider action
- Results reported together
Order Cancellation
When order no longer needed:
- Update
status: "revoked" - Document cancellation reason
- Notify laboratory
- Stop specimen collection
- Update patient
Related Entities
| Entity | Relationship | Description |
|---|---|---|
| Patient | References | Who the test is for |
| Encounter | References | Visit context |
| LabTest | References | Test being ordered |
| Practitioner | References | Ordering provider |
| Facility | References | Performing laboratory |
| Specimen | Has many | Collected specimens |
| Coding | Contains | Reason codes |
| ClinicalIdentifier | Contains | Order identifiers |
| LaboratoryResult | Referenced by | Test results |
Calculated Fields
| Field | Type | Description |
|---|---|---|
isActive | boolean | True when status is active |
isPending | boolean | True when not completed, revoked, or error |
Enums
status
| Value | Description |
|---|---|
draft | Order is being composed but not yet finalized |
active | Order is active and awaiting specimen collection or processing |
on-hold | Order temporarily paused pending resolution of an issue |
revoked | Order has been cancelled and should not be performed |
completed | Order has been fulfilled and results are available |
entered-in-error | Order was created in error and should be disregarded |
unknown | Order status cannot be determined |
intent
| Value | Description |
|---|---|
proposal | Suggestion for ordering provider consideration |
plan | Intended future order, not yet actionable |
directive | Authoritative instruction requiring action |
order | Actionable request authorized by provider |
original-order | First order for this test |
reflex-order | Auto-generated based on previous result or protocol |
filler-order | Created by laboratory based on clinical need |
instance-order | Single instance of a standing order |
priority
| Value | Description |
|---|---|
routine | Standard processing with normal turnaround time |
urgent | Same-day processing required |
asap | Process as soon as possible, within hours |
stat | Immediate processing required for emergency situations |
Properties
| Property | Type | Mode | Description | Required |
|---|---|---|---|---|
| identifier | ClinicalIdentifier[] | 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: | Optional |
| patient | Patient | stored | Reference to the patient for whom the laboratory tests are being ordered and from whom specimens will be collected | Required |
| encounter | Encounter | stored | Reference to the healthcare encounter during which this laboratory order was created, linking the order to the specific clinical context and visit Example: | Optional |
| status | string | 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: Example: | Required |
| intent | string | 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: Example: | Required |
| priority | string | stored | Urgency level of the laboratory order that drives specimen processing priority, turnaround time expectations, and resource allocation in the laboratory workflow Values: Example: | Required |
| code | LabTest | stored | Reference to the standardized laboratory test being ordered, specifying the exact diagnostic procedure to be performed with LOINC or other standard coding Example: | Required |
| orderingPractitioner | Practitioner | stored | Reference to the healthcare practitioner who authorized and placed the laboratory order, establishing clinical responsibility and providing contact for result reporting Example: | Required |
| authoredOn | DateTime | 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: | Required |
| reasonCode | Coding[] | 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: | Optional |
| reasonText | string | 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: | Optional |
| specimen | Specimen[] | stored | Specification of the biological specimen type and collection requirements for the ordered laboratory test, providing guidance for specimen collection, handling, and processing | Optional |
| performerLab | Facility | stored | Reference to the specific laboratory facility or organization designated to perform the ordered test, enabling proper order routing and result reporting Example: | Optional |
| note | string | stored | Additional instructions, special handling requirements, or clinical context information for laboratory staff performing the test, ensuring proper test execution and result interpretation Example: | Optional |
| scheduledDateTime | DateTime | 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: | Optional |
| isActive | boolean | 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 |
| isPending | boolean | 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"
}