hl7 fhir bridge

Verdict: converted, but not US Core-ready. I validated against the us-core profile and got 1 error and 2 warnings. I also found two blocking problems the validator doesn't check: the DiagnosticReport has no status, and the timestamps have no time zone. Both are under "Not checked by the engine" below.

This is a translation and validation aid, not a medical device. These results will reach patients, so have someone check the mapped output before go-live.

Resources

Observation.category = laboratory is a fixed value the ORU map always sets, because HL7 v2 has no field for it. It isn't a guess.

Issues (from the engine)

Not checked by the engine (my observations)

I confirmed each of these by parsing the message or reading the Bundle. They're my own findings, separate from the deterministic list above.

1. The DiagnosticReport has no status, which makes it invalid FHIR R4. The OBR segment has only 24 fields, so the F landed in OBR-24 (diagnostic service section) instead of OBR-25 (result status). The | before it is one short. status is mandatory (1..1) in base FHIR R4 and in US Core. I re-ran a synthetic message with F in OBR-25 and it mapped to status: final.

Timestamps have no time zone. OBX-14 20261014084000 becomes 2026-10-14T08:40:00. FHIR R4 doesn't allow a dateTime with a time but no offset, so strict FHIR parsers will reject it. MSH-7 and OBR-7 have the same problem. I checked that an offset sent by the lab (e.g. …084000-0500) is kept in the output.
3.

The DiagnosticReport has no effective/issued time. OBR-7 (collection time) is in the message, but the ORU map doesn't map OBR-7 or OBR-22 yet (documented as pending). OBR-22 (report time) is also empty in the message. US Core's lab DiagnosticReport expects an effective time. This is a gap in the map, not a lab error.
4.

The order and report IDs aren't carried over. OBR-2 (placer ORD-5521) and OBR-3 (filler ACME-77310) don't reach DiagnosticReport.identifier or basedOn. Without them, a later corrected result can't be matched to this one, and your app would show duplicates. Map side.
5.

Patient.identifier.system is "CLINIC", not a URI. The map copies PID-3.4 (assigning authority) as-is. This is a known, deliberate TODO(mapeo) gap in the ORU map. It passes the engine's US Core rule because system and value are both present, but it isn't a resolvable namespace. This is your own MRN echoed back, so you decide the URI, not the lab.
6.

The NTE probably sits in the wrong place. It comes right after OBX 2, so under HL7 rules it's a note on the urine-color result. The text reads like a note about the whole specimen.
7. Minor gaps:

• The middle initial (PID-5.3) isn't mapped.
• valueQuantity carries only the mg/dL text, with no UCUM system/code. It stays that way even if OBX-6 says ^^UCUM, which I checked. It's fine for display, but the map needs it if the app compares or converts units.

The engine checks structure and must-support elements for Patient, Observation and codings. It doesn't check full IG conformance or terminology bindings. Before go-live, run the official HL7 FHIR Validator with US Core as a second pass.

What to ask Acme Lab to fix

1. Populate PID-8 (administrative sex). This clears the only US Core error.

Put the result status in OBR-25. Add the missing | before F. Right now it lands in OBR-24 and the report has no status.
3. Send timestamps with a UTC offset in MSH-7, OBR-7 and OBX-14, e.g. 20261014084000-0500.
4.

Code coded results with a standard system. Send a LOINC answer or SNOMED CT code in OBX-5.4–5.6 with coding system LN or SCT, and/or tell us the canonical URI of 99ACME.
5. Two smaller items:

• Populate OBR-22 (report time).
• Check where the NTE belongs. If the note is about the whole specimen, they should send it right after OBR instead of after the urine-color OBX.

Bundle (exactly as produced)

{
  "resourceType": "Bundle",
  "type": "collection",
  "entry": [
    {
      "fullUrl": "urn:uuid:4d76e1a9-53d4-42ad-94e1-04d8cd13997e",
      "resource": {
        "resourceType": "Patient",
        "identifier": [
          {
            "value": "MRN-88231",
            "system": "CLINIC"
          }
        ],
        "name": [
          {
            "family": "RIVERA",
            "given": [
              "ANA"
            ]
          }
        ],
        "birthDate": "1987-04-12"
      }
    },
    {
      "fullUrl": "urn:uuid:386051ae-c102-4c64-8ccc-da62ab40eca6",
      "resource": {
        "resourceType": "Observation",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory"
              }
            ]
          }
        ],
        "status": "final",
        "code": {
          "coding": [
            {
              "code": "2350-7",
              "display": "GLUCOSE UR",
              "system": "http://loinc.org"
            }
          ]
        },
        "valueQuantity": {
          "value": 100,
          "unit": "mg/dL"
        },
        "interpretation": [
          {
            "coding": [
              {
                "code": "H",
                "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
              }
            ]
          }
        ],
        "referenceRange": [
          {
            "text": "<15"
          }
        ],
        "effectiveDateTime": "2026-10-14T08:40:00",
        "subject": {
          "reference": "urn:uuid:4d76e1a9-53d4-42ad-94e1-04d8cd13997e"
        }
      }
    },
    {
      "fullUrl": "urn:uuid:f306779d-0e58-4e43-acd6-c051ed13b5c3",
      "resource": {
        "resourceType": "Observation",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory"
              }
            ]
          }
        ],
        "status": "final",
        "code": {
          "coding": [
            {
              "code": "5778-6",
              "display": "COLOR OF URINE",
              "system": "http://loinc.org"
            }
          ]
        },
        "valueCodeableConcept": {
          "coding": [
            {
              "code": "DKYEL",
              "display": "DARK YELLOW"
            }
          ]
        },
        "effectiveDateTime": "2026-10-14T08:40:00",
        "subject": {
          "reference": "urn:uuid:4d76e1a9-53d4-42ad-94e1-04d8cd13997e"
        }
      }
    },
    {
      "fullUrl": "urn:uuid:7e621ab3-2718-4b83-9759-7010e94d71dc",
      "resource": {
        "resourceType": "DiagnosticReport",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/v2-0074",
                "code": "LAB"
              }
            ]
          }
        ],
        "code": {
          "coding": [
            {
              "code": "24357-6",
              "display": "URINALYSIS MACRO PANEL",
              "system": "http://loinc.org"
            }
          ]
        },
        "result": [
          {
            "reference": "urn:uuid:386051ae-c102-4c64-8ccc-da62ab40eca6"
          },
          {
            "reference": "urn:uuid:f306779d-0e58-4e43-acd6-c051ed13b5c3"
          }
        ],
        "subject": {
          "reference": "urn:uuid:4d76e1a9-53d4-42ad-94e1-04d8cd13997e"
        }
      }
    }
  ]
}

Next steps

1. Send the lab list above to Acme. Items 1–3 block US Core and valid R4. Item 4 removes the coding warning.
2. Extend the ORU map on our side:
   • Map OBR-7 → DiagnosticReport.effectiveDateTime, OBR-22 → issued, and OBR-2/OBR-3 → identifier.
   • Map NTE → Observation.note.
   • Register the 99ACME URI once Acme provides it.
   • Decide the URI for the CLINIC MRN namespace.

Re-test with a corrected sample. Re-run map --profile us-core on a corrected sample from Acme, then run the official HL7 FHIR Validator (US Core) as a second pass before go-live.