NPEx

USER GROUP

2017

Complex Reporting

• What happened last year?

• A pragmatic approach & proposed ‘standard’

• What’s coming for HL7v2 that may be relevant

• Discussion

2

2015’s proposal - workflow

OrderN

InvestigationsPerform Test(s)

Return1

investigation result

Break into constituent parts

Return single or multiple results?

Return 1 investigation result

and close all requests with

comment

ReturnN

Results

Single

Multiple

Use template to find distinct sections

Map all Test & Result Codes

UserVerification

3

2015’s proposal - verification

4

Domain model (simplified)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540481/

CDC model:

Single Order

Multiple Specimens

Multiple Cultures

Multiple Isolates

Multiple Sensitivities

5

It’s a hierarchy!

3. One culture with two susceptibility groupings for one organism, (Scenario 3), page 23

• • Staphylococcus aureus identified with a colony count of 10,000 to 90,000. This isolate is Resistant to Ampicillin with an MIC of 32 μg/mL,

Sensitive to Amoxicillin/Clavulanic Acid with an MIC of 2μg/mL, Sensitive to Cefazolin with an MIC of 8 μg/mL

• • Beta hemolytic Streptococcus A identified with a colony count of <1,000

• • Haemophilus influenzae identified with a colony count of 10,000 – 90,000. This isolate is Sensitive to Ampicillin by Kirby-Bauer,

Amoxicillin/Clavulanic Acid by Kirby-Bauer, Cefazolin by Kirby-Bauer

• >Note: OBR-26 - Parent Result and OBR-29 – Parent in the second and third OBR segments provide “linkage” back to particular isolates in the

original order/result. This is discussed in more detail in the Segment Details section for the OBX segment.

• MSH|YadaYadaYada<cr>PID|||RhubarbRhubarb<cr>ORC|BlahBlah

• OBR|1|0889436^GoodDr|ABC012345^LabOne|6460-0^Spt RoutineCult^LN

|||20011001091234|||||||200110010823|SPT&Sputum&HL70070|^Good^Robert^^^^MD^^L||||||20011002072359||MB|P

– OBX|1|CE|11475-1^MICROORGANISM IDENTIFIED:^LN|1| L-24801^Staphylococcus aureus^SNM

– OBX|2|CE|564-5^Colony count^LN |1|10,000-90,000

– OBX|3|CE|11475-1^MICROORGANISM IDENTIFIED:^LN|2|L-25128^Beta hemolytic Streptococcus A^SNM

– OBX|4|CE|564-5^Colony count^LN |2|<1,000

– OBX|5|CE|11475-1^MICROORGANISM IDENTIFIED:^LN|3|L-13401 ^Haemophilus influenzae^SNM

– OBX|6|CE|564-5^Colony count^LN|3|10,000-90,000

• OBR|2||ABC012346^LabOne|29576-6^Bacterial Susc PanelIslt^LN||||||||||||||||||||||

• 11475-1&MICROORGANISMIDENTIFIED:&LN^1^Staphylococcusaureus|||0889436&GoodDr^ABC012345&LabOne

– OBX|1|CE|28-1^Ampicillin MIC^LN|1|32|μg/mL||R

– OBX|2|CE|32-3^AmoxCla MIC^LN |1|2|μg/mL||S

– OBX|3|CE|76-0^Cefazolin MIC^LN |1|8|μg/mL||S

• OBR|3||ABC012347^LabOne|29576-6^Bacterial Susc PanelIslt^LN||||||||||||||||||||||

• 11475-1&MICROORGANISMIDENTIFIED:&LN^3^Haemophilusinfluenzae|||0889436&GoodDr^ABC012345&LabOne

– OBX|1|CE|29-9^Ampicillin KB^LN|3||||S

– OBX|2|CE|21-6^AmoxCla KB^LN|3||||S

– OBX|3|CE|77-8^Cefazolin KB^LN|3||||S

6

HL7 2.5.1 Ch7, Observations

7

8

ASL/ARL in Telepath & APEX

9

00|PMEP||||850fcbd6-ee7a-4c2a-b598-

6b19910db433|20160609144605.3807+0000|

10|$$$|||

12||||||

14||||||

16|||

20|STPHL|STPHL|

22||| 24|R,16.0338745.Q|20160609154100|

30|9999999476|00742749|XXXXXXXX||

40|1|R,16.0338745.Q|201606090900||B|||

50|ASL|1|1|||GSA|Swab analysis||||||||

52|General growth information goes here.|

50|ARL|1||||CULT|Culture|||||||| (may need to be text result)

50|ARL|1||||STAPHA|Staphococolis|||||||| (may need to be text result)

52|Doesn’t look very nice.|

50|ARL|1||||CCC|Colony count|100000|7|cfu/ml|||||

50|ARL|1||||AB1|Fooicillin|2|7|ug/ml|2|8|?HI/LO?||

50|ARL|1||||AB2|Barafloxacin|16|6|ug/ml|4|16|?HI/LO?||

50|ARL|1||||AB3|Bazithromycin|4|7|ug/ml|4|8|?HI/LO?||

50|ASL|1|2|||GSA|Swab analysis||||||||

50|ARL|2||||CULT|Culture||||||||

50|ARL|2||||STAPHA|Staphococolis||||||||

50|ARL|2||||CCC|Colony count|100000|7|cfu/ml|||||

50|ARL|2||||AB2|Barafloxacin|7.20||ug/ml|4|16|?HI/LO?|| --?Indeterminate?

50|ARL|2||||AB3|Bazithromycin|4|7|ug/ml|4|8|?HI/LO?||

50|ARL|2||||AB9|Quxycycline|8|6|ug/ml|4|8|?HI/LO?||

Conversion to freetext

10

• HL7* and PMIP interfaces will need to be modified in

order to cope with OBX:4 (PMIP 50:3)

• Updates will be achieved by resending WHOLE report

• We are able to cope with variations and will comply with

pre-existing interfaces, but would prefer a consistent

approach for all HL7 interfaces.

• Questions

– Is this approach workable?

– Has anyone used/seen Clinisys Z segments in the wild?

– Has anyone seen/used Winpath csv microbiology results?

– Is the PMIP approach workable?

– Who is going to approach each of the suppliers?

11

* some systems MAY already have pre-existing capabilities, eg Labcentre, EPIC (using nested OBRs?),

Sunquest, SwissLab, Winpath (using Z segments). NPEx will conform to these standards, assuming they

actually work!

HL7 2.8.2 Ch7, Observations

12

HL7 2.8.2 Ch2A, DataTypes

13

OBX 4, ‘original’ mode

14

OBX 4, ‘enhanced’ mode

15

Genomics

16

HistoPathology Workflow

LIS /

APLIS

Slide prep data

Whole Slide

Scanner

PACS

Images w/

slide prep data

Pathology

Workstation

Images

Gross

specimen

accessioning

Specimen

Images

Surgical or

biopsy

procedure

Images – X-ray, U/S,

optical, etc.

Slide preparation

Case info

Pathology

Order &

Specimen

info

Slide ID

Scanning orders

Adapted from H Solomon GE

HistoPathology (Anatomic) Pathology

18

Dicom/ HL7 CDA work

19

More Hierarchies!

Reporting Guidelines for Clinical Laboratory Reports in

Surgical Pathology, 2008, Goldsmith et al

Questions?/Discussion?

20