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Diagnostic Results and Image Exchange

For named laboratories, trusts and boards, see UK Diagnostic Order Comms and Results. Its provider matrix separates clinician ordering/results, LIMS, RIS/PACS and lab exchange, with a filterable map.

Diagnostic connectivity covers several different tasks: delivering a laboratory result, discovering an earlier scan, retrieving its report and transferring the images themselves. England's new pathology reporting service and National Imaging Registry address different parts of this landscape. Scotland, Wales and Northern Ireland have their own diagnostic systems and exchange routes.

Use the UK Healthcare Connectivity Landscape for the overall map and England Spine and National Services for the national infrastructure around these services. Programme sources were checked on 15 September 2026; the requesting-route clarification below was added on 16 September 2026.

England: Current and Planned Routes

Requesting Through Trusts and Laboratories

Pathology ordering is trust/laboratory based: NHS England describes GP ordering applications connecting to the receiving laboratory's information system (LIMS), and hospital requests originating in the trust's clinical system. National Pathology Exchange (NPEx) serves a different function: laboratory-to-laboratory requests and results, including specialist referrals between participating UK laboratories.

Radiology requesting is trust/imaging-provider based. For example, University Hospitals Birmingham's diagnostic requesting guidance describes GP pathology and imaging requests going into its hospital laboratory and radiology systems. This demonstrates provider delivery, not one national ordering platform or a uniform regional arrangement.

The core-services matrix therefore labels these delivery routes explicitly. Local product examples explain the route without becoming national equivalents.

Reporting and Retrieval Services

Service or route What moves Current position Technical route
Pathology Messaging – EDIFACT Laboratory reports to GP systems. Production; under review for deprecation, with no agreed retirement date. EDIFACT NHS003 v1.003 through MESH.
Pathology and Laboratory Medicine Reporting – FHIR API Structured pathology reports, initially for GP-requested tests. Pilot underway; API alpha with restricted onboarding. Assurance target April 2027 precedes wider rollout. FHIR R4 document Bundles through the Pathology API, Patient Data Manager and Multicast Notification Service.
National Imaging Registry (NIR) Discovery of imaging history, retrieval of reports/manifests and retrieval of images. Production beta; service page reports three live imaging networks. National rollout planned for 2026–27. SOAP/IHE XCA and XCA-I today. FHIR/MHD and DICOMweb WADO-RS are planned.

Pathology: The Transition from MESH to APIs

The official name is Pathology and Laboratory Medicine Reporting – FHIR API. “Pathology results exchange” describes its function; it should not be treated as a separate confirmed service name.

The documented pilot route is:

flowchart LR
    L[Laboratory middleware] --> A[Pathology API]
    A --> P[Patient Data Manager]
    A --> N[Multicast Notification Service]
    N --> G[GP system]
    G -->|Retrieve result| P

The API accepts a report, stores it in Patient Data Manager (PDM) and publishes a notification through Multicast Notification Service (MNS). The receiving GP system then retrieves the result. This is designed to replace the MESH delivery approach for this diagnostic flow; it does not announce retirement of MESH across the NHS.

The July 2026 implementation update describes pilot work with EMIS, Optum, Clinisys and Iuvo, supported by Berkshire and Surrey NHS Pathology Service. Testing and assurance are intended to finish by April 2027, followed by GP supplier roadmaps and rollout. NHS England says the DAPB4101 conformance deadline will be extended; the original April 2025 milestone is not evidence that implementation is complete.

Pathology: Standards and Versions

Layer Published position
Information standard DAPB4101, Pathology and Laboratory Medicine Reporting Information Standard, release 15 April 2024. Read it alongside the updated implementation timetable.
Implementation guide Pathology FHIR IG 0.5.0, released 13 July 2026; FHIR R4 4.0.1, with pathology package 0.2.4-alpha.
Report structure A document Bundle with Composition. The 2026 guide now combines NHS England, HL7 Europe Laboratory Report and UK Core profiles; older message-Bundle examples are superseded.
Coding Read PBCL is being replaced by SNOMED PBCL, with gradual adoption of PaLM terminology. Interim PBCL use remains part of the transition.
API OpenAPI 0.1.0, POST /FHIR/R4/Bundle; internet-facing, application-restricted access. The catalogue lists alpha onboarding and an integration environment.

The initial clinical scope is GP-requested blood sciences and microbiology reporting. The guide remains under development, including parts of transport, error handling and acknowledgements. Its UK Core “STU3 Sequence” reference must not be confused with the older FHIR DSTU3 format used by the separate Lab Results adaptor. See Terminology Code Management for the wider PBCL and SNOMED mapping context.

Imaging: NIR and the Image Exchange Portal

National Imaging Registry (NIR) is part of NHS England's Diagnostics Digital Capability Programme. Its role is to let connected systems find and retrieve imaging information across organisations. NHS England describes reduced reliance on Image Exchange Portal (IEP) transfers and costs; it does not publish an IEP shutdown date in these sources.

Operation Current NIR interface What the result means
Find prior examinations IHE XCA ITI-38 Discover records at participating imaging networks.
Retrieve a report or imaging manifest IHE XCA ITI-39 Obtain the diagnostic document or the manifest identifying its images.
Retrieve the images IHE XCA-I RAD-75, using WADO-WS Obtain image data after discovery; this is a distinct operation from reading the report.

The current API specification is v0.32.0 and describes SOAP/XCA interfaces. Its title includes “MHD FHIR API”, but its technical description explicitly places the MHD/FHIR R4 endpoint in the future. The roadmap also includes WADO-RS, FHIR registry integration and wider network coverage; these should not be represented as completed national capabilities.

NIR supplies no new clinical viewer and does not replace local PACS or RIS systems. Images and reports remain with originating organisations. Local systems must integrate discovery and viewing; some connected systems support document discovery before full image retrieval.

The service page retains mixed wording about approaching private-beta go-live and actual live use. The useful operational reading is limited beta use, with business-hours support and further rollout planned. It is already more than a procurement proposal, but it is not evidence that IEP has been replaced throughout England.

Diagnostic Routes Across the UK

Nation Where to follow the diagnostic route Boundary
England The pathology and NIR sections above, alongside England's national services. Laboratory reporting, report discovery and image retrieval use different services and implementation stages.
Scotland Scotland diagnostic exchange: PACS and board image-transfer services, with SCI Store and pathway-specific NDP/SCI Gateway connections. PACS reprocurement does not establish completed replacement. NHSGGC's local transfer guidance was reviewed in July 2023 and was due for review in July 2026.
Wales Wales connectivity: Welsh Clinical Portal, Welsh Results Reporting Service and LIMS/TrakCare Lab Enterprise for laboratory workflows; RISP for imaging. February 2026 programme reporting records phased laboratory deployment and imaging go-lives. The TrakCare laboratory interfaces and the separately procured RISP imaging stack have different suppliers and migration schedules.
Northern Ireland Northern Ireland connectivity: CoreLIMS for laboratories, NIPACS+ for imaging and encompass/EpicCare Link for clinical access. BSO reported CoreLIMS rollout across 11 hospitals in March 2026; June reporting described NIPACS+ programme closure and operational handover planned for July. My Care separately excludes GP-requested results.

InterSystems Relevance

Health Connect, IRIS for Health and HealthShare provide integration, transformation, record and presentation capabilities that may be used within diagnostic routes. A product's support for FHIR, DICOM or IHE does not establish that it has joined these national services. The reviewed England sources do not identify a live InterSystems implementation of the new pathology API or NIR (SRC-002, SRC-004, SRC-005, SRC-393 to SRC-400).

Primary Sources