FHIR: Not finding DiagnosticReport for patient id on SmartHealthIt server - hl7-fhir

Question

I'm trying to find DiagnosticReport resources for a given patient using the SmartHealthIt R4 server for testing (https://r4.smarthealthit.org).
I've loaded the Patient and DiagnosticReport resources shown below.
The patient has the following for id:
"resourceType": "Patient",
"id": "1435573",
The DiagnosticReport has the following for subject:
"subject": {
"reference": "Patient/1435573"
}
None of the following searches return this DiagnosticReport. How do I get all of the DiagnosticReport resources for Patient/1435573 including the one used in this example (I can modify the Patient, the DiagnosticReport, and/or the urls to get the result). The queries below are based on Hapi FHIR: searching for patient identifier using Postman. All of the queries give basically an empty bundle (contains only the self url) except for the last that gives an invalid query error.
Queries:
https://r4.smarthealthit.org/DiagnosticReport?subject=1435573
https://r4.smarthealthit.org/DiagnosticReport?patient.identifier=1435573
https://r4.smarthealthit.org/DiagnosticReport?subject=Patient/1435573
https://r4.smarthealthit.org/DiagnosticReport?subject=https://r4.smarthealthit.org/Patient/1435573
https://r4.smarthealthit.org/DiagnosticReport?subject=http://r4.smarthealthit.org/Patient/1435573
https://r4.smarthealthit.org/DiagnosticReport?subject.reference=1435573
(invalid parameter chain error)
Full Patient Resource (response from the url shown below):
https://r4.smarthealthit.org/Patient/1435573
{
"resourceType": "Patient",
"id": "1435573",
"meta": {
"versionId": "1",
"lastUpdated": "2022-11-20T12:31:20.724-05:00",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated by Synthea.Version identifier: master-branch-latest\n . Person seed: -3481236467670898486 Population seed: 1663786624475</div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "text",
"valueString": "White"
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
}
},
{
"url": "text",
"valueString": "Not Hispanic or Latino"
}
]
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
"valueString": "Natosha194 Rolfson709"
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "M"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
"valueAddress": {
"city": "Westfield",
"state": "Massachusetts",
"country": "US"
}
},
{
"url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
"valueDecimal": 0.011850126818590398
},
{
"url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
"valueDecimal": 30.98814987318141
}
],
"identifier": [
{
"system": "https://github.com/synthetichealth/synthea",
"value": "d7e5852a-974c-6d45-f81d-5a87bbd05d2a"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}
],
"text": "Medical Record Number"
},
"system": "http://hospital.smarthealthit.org",
"value": "d7e5852a-974c-6d45-f81d-5a87bbd05d2a"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "SS",
"display": "Social Security Number"
}
],
"text": "Social Security Number"
},
"system": "http://hl7.org/fhir/sid/us-ssn",
"value": "999-55-2948"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "DL",
"display": "Driver's License"
}
],
"text": "Driver's License"
},
"system": "urn:oid:2.16.840.1.113883.4.3.25",
"value": "S99934182"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PPN",
"display": "Passport Number"
}
],
"text": "Passport Number"
},
"system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
"value": "X1908681X"
}
],
"name": [
{
"use": "official",
"family": "Hermiston71",
"given": [
"Glenn0",
"Adalberto916"
],
"prefix": [
"Mr."
]
}
],
"telecom": [
{
"system": "phone",
"value": "555-370-8941",
"use": "home"
}
],
"gender": "male",
"birthDate": "1960-07-09",
"deceasedDateTime": "1992-06-21T18:48:35-04:00",
"address": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/geolocation",
"extension": [
{
"url": "latitude",
"valueDecimal": 42.1419070399434
},
{
"url": "longitude",
"valueDecimal": -71.28041093915812
}
]
}
],
"line": [
"236 Halvorson Mews Suite 21"
],
"city": "Walpole",
"state": "MA",
"country": "US"
}
],
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M",
"display": "M"
}
],
"text": "M"
},
"multipleBirthBoolean": false,
"communication": [
{
"language": {
"coding": [
{
"system": "urn:ietf:bcp:47",
"code": "en-US",
"display": "English"
}
],
"text": "English"
}
}
]
}
Full DiagnosticReport Resource (response from the url shown below):
https://r4.smarthealthit.org/DiagnosticReport/1435574
{
"resourceType": "DiagnosticReport",
"id": "1435574",
"meta": {
"versionId": "1",
"lastUpdated": "2022-11-20T12:36:53.205-05:00",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note"
]
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"subject": {
"reference": "Patient/1435573"
},
"effectiveDateTime": "1978-09-02T17:57:46-04:00",
"issued": "1978-09-02T17:57:46.296-04:00",
"performer": [
{
"display": "Dr. Debbie941 Macejkovic424"
}
],
"presentedForm": [
{
"contentType": "text/plain; charset=utf-8",
"data": "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"
}
]
}
--- EDIT ---------------------------------------
This query (suggested in answer below) also does not work. Screen shots are for a newly create patient (the original was deleted).
https://r4.smarthealthit.org/DiagnosticReport?patient=1437050
--- EDIT: STEPS TO REPRODUCE ---------------------------------
It looks like the patients created by end users are routinely deleted from this server (which makes sense). Here are the steps to reproduce the issue.
POST this messge to https://launch.smarthealthit.org/v/r4/fhir/Patient
{
"identifier": [
{
"system": "https://github.com/synthetichealth/synthea",
"value": "d7e5852a-974c-6d45-f81d-5a87bbd05d2a"
},
{
"system": "http://hospital.smarthealthit.org",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}],
"text": "Medical Record Number"
},
"value": "d7e5852a-974c-6d45-f81d-5a87bbd05d2a"
},
{
"system": "http://hl7.org/fhir/sid/us-ssn",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "SS",
"display": "Social Security Number"
}],
"text": "Social Security Number"
},
"value": "999-55-2948"
},
{
"system": "urn:oid:2.16.840.1.113883.4.3.25",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "DL",
"display": "Driver's License"
}],
"text": "Driver's License"
},
"value": "S99934182"
},
{
"system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PPN",
"display": "Passport Number"
}],
"text": "Passport Number"
},
"value": "X1908681X"
}
],
"extension": [
{
"extension": [
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
},
"url": "ombCategory"
},
{
"valueString": "White",
"url": "text"
}
],
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
},
{
"extension": [
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
},
"url": "ombCategory"
},
{
"valueString": "Not Hispanic or Latino",
"url": "text"
}
],
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
},
{
"valueString": "Natosha194 Rolfson709",
"url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName"
},
{
"valueCode": "M",
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex"
},
{
"valueAddress": {
"country": "US",
"city": "Westfield",
"state": "Massachusetts"
},
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace"
},
{
"valueDecimal": 0.011850126818590398,
"url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years"
},
{
"valueDecimal": 30.98814987318141,
"url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years"
}
],
"address": [{
"country": "US",
"extension": [{
"extension": [
{
"valueDecimal": 42.1419070399434,
"url": "latitude"
},
{
"valueDecimal": -71.28041093915812,
"url": "longitude"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/geolocation"
}],
"city": "Walpole",
"line": ["236 Halvorson Mews Suite 21"],
"state": "MA"
}],
"gender": "male",
"multipleBirthBoolean": false,
"birthDate": "1960-07-09",
"meta": {"profile": ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"]},
"deceasedDateTime": "1992-06-21T18:48:35-04:00",
"name": [{
"given": [
"Glenn0",
"Adalberto916"
],
"use": "official",
"prefix": ["Mr."],
"family": "Hermiston71"
}],
"telecom": [{
"system": "phone",
"use": "home",
"value": "555-370-8941"
}],
"text": {
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated by <a href=\"https://github.com/synthetichealth/synthea\">Synthea<\/a>.Version identifier: master-branch-latest\n . Person seed: -3481236467670898486 Population seed: 1663786624475<\/div>",
"status": "generated"
},
"communication": [{"language": {
"coding": [{
"system": "urn:ietf:bcp:47",
"code": "en-US",
"display": "English"
}],
"text": "English"
}}],
"maritalStatus": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M",
"display": "M"
}],
"text": "M"
},
"resourceType": "Patient"
}
Modify this message by replacing PATIENT_ID with the id returned when the Patient resource is posted and then post that to https://launch.smarthealthit.org/v/r4/fhir/DiagnosticReport
{
"code": {"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]},
"performer": [{
"display": "Dr. Debbie941 Macejkovic424"
}],
"effectiveDateTime": "1978-09-02T17:57:46-04:00",
"meta": {"profile": ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note"]},
"subject": {"reference": "https://r4.smarthealthit.org/Patient/PATIENT_ID"},
"presentedForm": [{
"data": "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",
"contentType": "text/plain; charset=utf-8"
}],
"category": [{"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]}],
"issued": "1978-09-02T17:57:46.296-04:00",
"resourceType": "DiagnosticReport",
"status": "final"
}
Then try to find the DiagnosticReport using the information (e.g. ID) for the Patient.

Answer 1

It appears the Patient and DiagnosticReport are now deleted, but you can use the patient search parameter. For example, https://r4.smarthealthit.org/DiagnosticReport?patient=3190019b-9001-4e31-a3c4-380b12b8002a currently returns a Bundle of 5 DiagnosticReports.