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5 · Resultado do exame (Bundle transaction)

Sistema: Lab+ (Laboratório) · Recursos: Observation ×4, DiagnosticReport, ServiceRequest (atualização)

O laudo do hemograma envolve seis operações: criar as 4 Observation (uma por analito), criar o DiagnosticReport que as referencia e concluir o ServiceRequest do pedido. O Lab+ envia tudo em um único POST com um Bundle do tipo transaction: o servidor aplica as seis operações atomicamente — ou tudo entra, ou nada entra.

Gravação — POST / (raiz) com Bundle transaction

curl -X POST 'http://localhost:8080/fhir' \
  -H 'Content-Type: application/fhir+json' \
  -d @resultado.json

Pontos-chave do bundle:

  • Cada Observation recebe um fullUrl temporário urn:uuid:…;
  • O DiagnosticReport.result referencia esses urn:uuid — o servidor reescreve as referências para os ids definitivos (Observation/91, …);
  • O basedOn aponta o ServiceRequest já existente, por referência literal;
  • A última entry é um PUT que conclui o pedido (status: completed), preservando a meta.tag original do iSUS APS (quem atualiza recurso alheio não troca a tag do criador).
resultado.json (valores da demonstração — dengue grave)
{
  "resourceType": "Bundle",
  "type": "transaction",
  "entry": [
    {
      "fullUrl": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000001",
      "resource": {
        "resourceType": "Observation",
        "status": "final",
        "category": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory"}]}],
        "code": {
          "coding": [{"system": "http://loinc.org", "code": "718-7", "display": "Hemoglobina"}],
          "text": "Hemoglobina"
        },
        "subject": {"reference": "Patient/42"},
        "effectiveDateTime": "2026-09-10T10:12:00-03:00",
        "valueQuantity": {"value": 14.2, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL"},
        "referenceRange": [{
          "low": {"value": 13.2, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL"},
          "high": {"value": 16.6, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL"}
        }],
        "meta": {"tag": [{"system": "https://demo-cbis.example/fhir/source-system", "code": "labmais", "display": "Lab+"}]}
      },
      "request": {"method": "POST", "url": "Observation"}
    },
    {
      "fullUrl": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000002",
      "resource": {
        "resourceType": "Observation",
        "status": "final",
        "category": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory"}]}],
        "code": {
          "coding": [{"system": "http://loinc.org", "code": "4544-3", "display": "Hematócrito"}],
          "text": "Hematócrito"
        },
        "subject": {"reference": "Patient/42"},
        "effectiveDateTime": "2026-09-10T10:12:00-03:00",
        "valueQuantity": {"value": 48.0, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%"},
        "referenceRange": [{
          "low": {"value": 38.8, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%"},
          "high": {"value": 50.0, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%"}
        }],
        "meta": {"tag": [{"system": "https://demo-cbis.example/fhir/source-system", "code": "labmais", "display": "Lab+"}]}
      },
      "request": {"method": "POST", "url": "Observation"}
    },
    {
      "fullUrl": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000003",
      "resource": {
        "resourceType": "Observation",
        "status": "final",
        "category": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory"}]}],
        "code": {
          "coding": [{"system": "http://loinc.org", "code": "6690-2", "display": "Leucócitos"}],
          "text": "Leucócitos"
        },
        "subject": {"reference": "Patient/42"},
        "effectiveDateTime": "2026-09-10T10:12:00-03:00",
        "valueQuantity": {"value": 2.1, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL"},
        "referenceRange": [{
          "low": {"value": 4.0, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL"},
          "high": {"value": 11.0, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL"}
        }],
        "interpretation": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "L", "display": "Low"}]}],
        "meta": {"tag": [{"system": "https://demo-cbis.example/fhir/source-system", "code": "labmais", "display": "Lab+"}]}
      },
      "request": {"method": "POST", "url": "Observation"}
    },
    {
      "fullUrl": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000004",
      "resource": {
        "resourceType": "Observation",
        "status": "final",
        "category": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory"}]}],
        "code": {
          "coding": [{"system": "http://loinc.org", "code": "777-3", "display": "Plaquetas"}],
          "text": "Plaquetas"
        },
        "subject": {"reference": "Patient/42"},
        "effectiveDateTime": "2026-09-10T10:12:00-03:00",
        "valueQuantity": {"value": 42.0, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL"},
        "referenceRange": [{
          "low": {"value": 150.0, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL"},
          "high": {"value": 450.0, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL"}
        }],
        "interpretation": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "L", "display": "Low"}]}],
        "meta": {"tag": [{"system": "https://demo-cbis.example/fhir/source-system", "code": "labmais", "display": "Lab+"}]}
      },
      "request": {"method": "POST", "url": "Observation"}
    },
    {
      "fullUrl": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000005",
      "resource": {
        "resourceType": "DiagnosticReport",
        "status": "final",
        "category": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory"}]}],
        "code": {
          "coding": [{"system": "http://loinc.org", "code": "58410-2", "display": "Hemograma completo"}],
          "text": "Hemograma completo"
        },
        "subject": {"reference": "Patient/42"},
        "basedOn": [{"reference": "ServiceRequest/10"}],
        "effectiveDateTime": "2026-09-10T10:12:00-03:00",
        "issued": "2026-09-10T10:12:00-03:00",
        "performer": [{"display": "Lab+ Análises Clínicas"}],
        "result": [
          {"reference": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000001", "display": "Hemoglobina"},
          {"reference": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000002", "display": "Hematócrito"},
          {"reference": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000003", "display": "Leucócitos"},
          {"reference": "urn:uuid:c1f4a6d0-93b1-4f52-8a41-000000000004", "display": "Plaquetas"}
        ],
        "conclusion": "Plaquetopenia acentuada, leucopenia e hemoconcentração — achados compatíveis com dengue grave.",
        "meta": {"tag": [{"system": "https://demo-cbis.example/fhir/source-system", "code": "labmais", "display": "Lab+"}]}
      },
      "request": {"method": "POST", "url": "DiagnosticReport"}
    },
    {
      "resource": {
        "resourceType": "ServiceRequest",
        "id": "10",
        "status": "completed",
        "intent": "order",
        "category": [{"coding": [{"system": "https://demo-cbis.example/fhir/category", "code": "laboratorio", "display": "Exame laboratorial"}]}],
        "code": {
          "coding": [{"system": "http://loinc.org", "code": "58410-2", "display": "Hemograma completo"}],
          "text": "Hemograma completo"
        },
        "subject": {"reference": "Patient/42"},
        "encounter": {"reference": "Encounter/7"},
        "authoredOn": "2026-09-10T09:35:00-03:00",
        "requester": {"display": "UBS Vila Esperança — iSUS APS"},
        "meta": {"tag": [{"system": "https://demo-cbis.example/fhir/source-system", "code": "isus-aps", "display": "iSUS APS"}]}
      },
      "request": {"method": "PUT", "url": "ServiceRequest/10"}
    }
  ]
}

Resposta — Bundle transaction-response

O servidor responde uma entry por operação, na mesma ordem do envio (exigência do FHIR R4), com o location de cada recurso:

{
  "resourceType": "Bundle",
  "type": "transaction-response",
  "entry": [
    {"response": {"status": "201 Created", "location": "Observation/91/_history/1"}},
    {"response": {"status": "201 Created", "location": "Observation/92/_history/1"}},
    {"response": {"status": "201 Created", "location": "Observation/93/_history/1"}},
    {"response": {"status": "201 Created", "location": "Observation/94/_history/1"}},
    {"response": {"status": "201 Created", "location": "DiagnosticReport/95/_history/1"}},
    {"response": {"status": "200 OK", "location": "ServiceRequest/10/_history/2"}}
  ]
}

Ao gravar, o servidor reescreveu o result do laudo: quem ler DiagnosticReport/95 encontrará {"reference": "Observation/91", "display": "Hemoglobina"}, e assim por diante. Se qualquer entry falhar (validação, conflito), nenhum recurso é gravado — o pedido segue active na worklist e o laboratório pode tentar de novo.

Leitura — laudos emitidos

O painel "Laudos emitidos" do Lab+ filtra pela tag de origem:

curl 'http://localhost:8080/fhir/DiagnosticReport?_tag=https://demo-cbis.example/fhir/source-system|labmais&_include=DiagnosticReport:subject&_sort=-issued'

O iSUS APS enxerga o mesmo laudo pela busca por paciente (passo 3), casando basedOn → ServiceRequest/10. A vigilância (CIMAN, passo 6) busca o laudo mais recente do paciente.