Pathology and laboratory medicine standards implementation

NHS England are updating the way pathology and laboratory medicine reports are flowed from labs to GP practices. Using SNOMED CT and FHIR, we have created 2 key data products to support pathology reporting and defined the DAPB4101 information standard that governs their use.

Source: Lord Carter of Coles - Pathology Transformation Review 2026

To help providers and system suppliers reach conformance with DAPB4101, NHS England are working to create a roadmap for national adoption.

Pathology and laboratory medicine test reports currently flow from labs to GP practices using the PMIP EDIFACT 003. Originally designed more than 25 years ago, PMIP EDIFACT has the following fundamental limitations:

It is unable to carry SNOMED CT. It can only support Read Pathology Bounded Code List (PBCL) codes.

Read PBCL is a fully withdrawn part of the standard. There can never be a new Read PBCL reportable to represent a new lab test. Therefore, PMIP EDIFACT itself cannot be used to send pathology reports for new lab tests.

As a message syntax, PMIP EDIFACT is unable to support complex report structures containing fully atomic, coded results such as microbiology or histopathology results. These currently flow to GPs only as non-machine-readable text.

In short, PMIP EDIFACT is outdated, and cannot handle modern, structured pathology data. This limits interoperability, automation, and clinical insight. The transition to DAPB4101 is required to ensure richer, machine-readable pathology data flows across NHS systems.

Implementation of this standard is also a fundamental requirement of the Carter report, and a professional requirement supported by the Royal College of GPs, the Institute of Biomedical Science, and the Royal College of Pathologists.

Conformance with DAPB4101 will bring many benefits to patients, clinicians and commissioners of NHS pathology services, including:

• the ability to code new pathology tests - new reportables can be created using a standardised, interoperable terminology
• modern, event-based, standards-compliant, 'platinum' service architecture – allows for more direct communication of vital clinical data, providing more options for consumption without the need for complex integrations, and better payload validation with message-by-message error handling
• 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 for AI - standardised, semantically interoperable and unambiguous pathology result data that supports machine-readability will enable AI-aided analytics, research and clinical decision support
• consistency of pathology reporting - across national applications and services, including the NHS App and Single Patient Record
• reduction of costs - clear, unambiguous pathology reporting will reduce the need for duplicate testing by clinicians and enable providers to review commissioning costs

The Pathology and Laboratory Medicine Reporting API enables the sharing of structured pathology test results from laboratory middleware systems to the requesting general practice organisation.

A pilot is underway that will establish and prove how a FHIR/SNOMED pathology report can be sent safely and ingested using the new architecture.

Testing will involve EMIS, the GP IT system supplier, and Optum, Clinisys and Iuvo, the 3 pathology middleware suppliers that enable national coverage for lab to GP reporting. Berkshire and Surrey NHS Pathology Service will support testing in a live first of type.

The intention is for testing and assurance to complete by April 2027.

DAPB4101 can then go onto GP IT system suppliers’ managed roadmap of work, leading to eventual national roll-out.

We are also looking to create maps between the most-used SNOMED PBCL reportables and SNOMED PaLM, to allow GP systems to record equivalent SNOMED PaLM reportables safely.

Full implementation of SNOMED PaLM will be gradual because of the impact to GP systems. Consequently, SNOMED PBCL will continue to flow in the interim.

The date for full conformance with DAPB4101 will be extended to align with the new timescales.