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Established Profile Laboratory Scheduled WorkFlow

Established Profile Laboratory Scheduled WorkFlow. Charles Parisot GE Healthcare IHE IT Technical Committee Co-chair François Macary AGFA Healthcare IT IHE Laboratory Committee Co-chair. Contributing countries France Japan Germany Italy The Netherlands UK US (CLSI - ex NCCLS).

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Established Profile Laboratory Scheduled WorkFlow

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  1. Established Profile Laboratory Scheduled WorkFlow Charles Parisot GE Healthcare IHE IT Technical Committee Co-chair François Macary AGFA Healthcare IT IHE Laboratory Committee Co-chair

  2. Contributing countries France Japan Germany Italy The Netherlands UK US (CLSI - ex NCCLS) Development started in 2003 First profile published in November 2003 10 systems validated in 2004 12 systems validated in 2005 Four new profiles currently published for public comment The IHE Laboratory Committee Cochairs: Francois Macary - Agfa Healthcare IT Yoshimitsu Takagi - Hitachi

  3. Five profiles: Laboratory Scheduled Workflow (LSWF) Laboratory Point Of Care Testing (LPOCT) Laboratory Device Automation (LDA) Laboratory Code Set Distribution (LCSD) Laboratory Information Reconciliation (LIR) Future plans Incorporate analyzer images in the result workflow Cross-enterprise sharing of lab reports, using CDA-R2 Specimen labels workflow IHE Lab today and to-morrow • Ordering, placing, scheduling and performing clinical laboratory tests both for Hospital and Ambulatory. • Microbiology included. Anatomic pathology and blood bank excluded

  4. Volume 1

  5. Integrate the clinical laboratory in the healthcare enterprise Workflow: Ordering, placing, scheduling, performing clinical laboratory tests, and delivering the results. In vitro testing: All specialties working on specimen, not on the patient itself. Bound to clinical biology (anatomic pathology excluded) Scope of LSWF profile

  6. Externally placed order with identified specimens The ordering provider collects the specimens and uniquely identifies them (in the message placing the order as well as on the container with a barcode label) Externally placed order with specimens unidentified or to be collected by the laboratory The specimens are unidentified within the message placing the order Filler order with specimens identified by the laboratory The order is created in the laboratory, and afterwards a number is assigned to it in the placer application. LSWF: Three major use cases

  7. IHE Laboratory: LSWF Patient Administration Rad-1, Rad-12 Rad1, Rad-12 Patient demographics & visit ADT Clinical validation Ward or EHR Clinical laboratory Lab-1: Placer order Order Placer Order Filler Lab-2: Filler order Lab-4: Work order Lab-5: Results Lab-3: Results Order Result Tracker Automation Manager Technical validation

  8. * In case the LIS encompasses both Order Filler and Automation Manager transactions LAB-4 and LAB-5 are irrelevant.

  9. Two parallel flows to keep synchronized Electronic: The order Material: The specimen(s) required to perform the order A dynamic process Specimen added by the placer to a running time study Specimen rejected by the filler (damaged or spoiled), tests held in wait for a new specimen Unordered test added by the filler (e.g. antibiogram in microbiology) Order management in LSWF profile Order Placer and Order Filler must keep the same vision of the order (content and status) all along the process

  10. Results can be transmitted at various steps After technical validation (by the lab technician) After clinical validation (by the clinical expert) Requirement to keep Order Result Tracker informed with all changes occurred to results previously sent Send corrections Send validation or un-validation Send cancellation Other characteristics Result type: Numeric, coded, textual, graphical (electrophoresis) Results are sent in recapitulative mode, appropriately sorted Results management in LSWF profile

  11. Laboratory Technical Framework Volume 2

  12. Need for an international standard, fully implementable with guides and tools ready for use Excluded HL7 v3 Supporting specimen and container management Excluded v2.3.1 and v2.4 Choice of HL7 v2.5, released just before IHE Lab TF (end 2003) Choice of the standard See Vol 2 section 1.1 HL7 v2.5 Transactions LAB-1, LAB-2, LAB-3, LAB-4, LAB-5 HL7 v2.3.1 Transactions RAD-1, RAD-12 Vertical bar encoding shall be supported. XML encoding may be supported

  13. Static definition: Usage of segments and fields R: Required RE: Required but may be empty O: Optional = Usage not defined yet C: Conditional (condition predicate in the textual description) X: Not supported. Must not be sent. For a better readability: Segments with usage X do not appear in message tables Fields with usage O do not appear in segment tables Cardinalities of segments, segment groups and fields: Min and max between square brackets: [0..*] * stands for “no upper limit” HL7 v2.5 profiling conventions See Vol 2 section 2.2

  14. Specimen Segment group Example of message static definition

  15. Example of segment description

  16. Filler Order Number (accepted battery) F101 F102 F103 Laboratory request 123 ordered battery 12347 accepted battery F103 Vocabulary & tracking orders The physician places a lab request. The Order Placer allocates the unique Id “123” to this request consisting of: Order Placer allocates an Identifier to each ordered battery Order Filler allocates an Identifier to each accepted battery • a CBC (complete blood count) • an electrolyte (Na, K, Cl) • a creatinine clearance

  17. Each example is using the same layout: Storyboard List of human actors and organizations Ids and numbers List of interactions Interaction diagram Messages with key information highlighted. Watch the 4 examples of section 9 For implementers: One of the most helpful parts of Laboratory Technical Framework.

  18. 1st example: Two hematology batteries

  19. 1st example: Two hematology batteries

  20. Two hematology batteries: One message

  21. An OML message shall be acknowledged by one single ORL message. An OUL message shall be acknowledged by one single ACK message. These acknowledgements are application-level acknowledgements (i.e. not transport acknowledgements) and must be generated by the receiving application after it has processed the message semantic content, according to its own business rules. Intermediate message brokers do not have this capacity and therefore shall not be used to generate the contents of application acknowledgements. The receiving application shall automatically generate the application-level acknowledgement messages without waiting for human approval of the contents of the message that was received Acknowledgements with MLLP (1) See Vol 2 section 2.3

  22. Thank you for your attention…

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