Pathology standards implementation

NHS England’s Pathology Standards Implementation programme is 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.

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

To help providers and system suppliers integrate our data products and reach conformance with the DAPB4101 information standard, we are working with NHS England’s Diagnostics Digital Capability and Digital Primary Care programmes. Together, we will create an implementation strategy, guidance and roadmap for national adoption; our role being to provide informatics support.

Currently the NHS uses a messaging standard called Pathology Messaging Implementation Programme (PMIP) Electronic Data Interchange for Administration, Commerce and Transport (EDIFACT) for transferring pathology data. DAPB4101 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 codes, which is a deprecated standard and was retired in April 2016 - it is no longer possible to create new Read codes
• unable to support complex report structures containing fully atomic, coded results – data elements are mainly represented as text
• 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

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.

Implementation of this standard is also a professional requirement supported by members of the Royal College of GPs and the Royal College of Pathologists.

Conformance with DAPB4101 integration – sending pathology messages using FHIR and SNOMED - will bring many benefits to patients, clinicians and commissioners of NHS pathology services, including:

• 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

To implement the new pathology messaging standard, we:

1. Published SNOMED CT content for pathology reporting and FHIR R4 profiles for pathology reporting – see Our products.
2. Published the DAPB4101 Pathology and Laboratory Medicine Reporting Information Standard, which includes implementation guidance and a requirements specification.
3. Will be supporting a laboratory information management system (LIMS) to GP data flow pilot, to establish and prove how a FHIR/SNOMED pathology report can be safely sent and ingested.
4. Are providing informatic support to providers, pathology LIMS and middleware suppliers, and GP system suppliers to integrate our data products.
5. Are working with aligned NHS programmes and services towards national adoption of FHIR/SNOMED pathology reporting.
6. Establishing best practice for laboratories to map legacy lab-specific request and result codes to SNOMED CT using NHS England Terminology Server.

In the pathology report sent from laboratories to primary care, the DAPB4101 information standard 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).

In terms of pathology specialisms, SNOMED CT currently covers:

• clinical biochemistry (also known as chemical pathology)
• haematology
• immunology
• transfusion medicine.
• microbiology (including bacteriology, virology, and serology)