VistA examples

We have a ParasitologyReport table with potentially many child records in the Parasitology table. The ParasitologyReport table does not include a status (required in DiagnosicReport but supports 'unknown'). The OrderedTest table does not seem to include tests for this domain, which is just as well, since the cardinality doesn't seem resolvable.

In both examples, the "proposed change" is intended to address the question of how to include multiple results. These instances lacks the required component.code, but that would just be "parasitology." The other option would be to have two distinct Observations in a DiagnosticReport.

Notes on Example 1: 
We have no test name, but we do know that the result is from the Parasitology table.
Hence:
  "code": {
    "text": "PARASITOLOGY"
  }

Results are from the associated Organism table, which contains references to SNOMED organism codes as well as text results for other kinds of resulte. Hence, 
  "valueCodeableConcept": {
    "text": "TRICHROME EXAM  :NEGATIVE"
  }
That test name and that result text both exist only in that text.

Notes on Example 2:
Same test code situation.

Organism results are actually encoded and will be included as encoded. The quantification (many, moderate) only occurs in the comment.

Example 1
Current:
{
  "cdwId": "12345:P",
  "status": "final",
  "category": "laboratory",
  "code": {
    "text": "PARASITOLOGY"
  },
  "subject": {
    "type": "Patient",
    "reference": "1015",
    "display": "PatientName"
  },
  "effectiveDateTime": "2009-10-07T16:24:32Z",
  "issued": "2009-10-13T20:51:00Z",
  "performer": [
    {
      "type": "Organization",
      "reference": "456:I",
      "display": "ANCHORAGE VA MEDICAL CENTER"
    }
  ],
  "valueCodeableConcept": {
    "text": "TRICHROME EXAM  :NEGATIVE"
  },
  "comment": "Performing Lab:QUEST DIAG.INC.2211 E.NO.LIGHTS.BLVD.ANCH.AK 99508 \rRESULT RECEIVED AND VERIFIED  10/13/09 \r",
  "specimen": {
    "type": "Specimen",
    "reference": "800000094",
    "display": "FECES"
  }
}



Proposed change:
{
  "cdwId": "12345:P",
  "status": "final",
  "category": "laboratory",
  "code": {
    "text": "PARASITOLOGY"
  },
  "subject": {
    "type": "Patient",
    "reference": "1015",
    "display": "PatientName"
  },
  "effectiveDateTime": "2009-10-07T16:24:32Z",
  "issued": "2009-10-13T20:51:00Z",
  "performer": [
    {
      "type": "Organization",
      "reference": "456:I",
      "display": "ANCHORAGE VA MEDICAL CENTER"
    }
  ],
  "comment": "Performing Lab:QUEST DIAG.INC.2211 E.NO.LIGHTS.BLVD.ANCH.AK 99508 \rRESULT RECEIVED AND VERIFIED  10/13/09 \r",
  "specimen": {
    "type": "Specimen",
    "reference": "800000094",
    "display": "FECES"
  },
  "components": [
    {
      "valueCodeableConcept": {
        "text": "CONCENTRATE EXAM:NEGATIVE"
      }
    },
    {
      "valueCodeableConcept": {
        "text": "TRICHROME EXAM  :NEGATIVE"
      }
    }
  ]
}

Example 2
Current:
{
  "cdwId": "1234:P",
  "status": "final",
  "category": "laboratory",
  "code": {
    "text": "PARASITOLOGY"
  },
  "subject": {
    "type": "Patient",
    "reference": "1003",
    "display": "PatientName"
  },
  "effectiveDateTime": "2009-10-02T11:30:00Z",
  "issued": "2009-10-09T07:00:00Z",
  "performer": [
    {
      "type": "Organization",
      "reference": "123:I",
      "display": "PALO ALTO VA MEDICAL CENTER"
    }
  ],
  "valueCodeableConcept": {
    "text": "DIENTAMOEBA FRAGILIS"
  },
  "comment": "MANY BLASTOCYSTIS HOMINIS \rMODERATE DIENTAMOEBA FRAGILIS \rTEST PERFORMED AT:SPECIALTY LABS, 27027 TOURNEY RD., VALENCIA, CA \r",
  "specimen": {
    "type": "Specimen",
    "reference": "800000106",
    "display": "FECES"
  }
}