IHE Laboratory
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Transcript of IHE Laboratory
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1September, 2005 What IHE Delivers
Cochairs:Cochairs: Francois Macary - Agfa HealthCare Francois Macary - Agfa HealthCare
Nobuyuki Chiba - A&T CorporationNobuyuki Chiba - A&T Corporation
IHE LaboratoryIHE Laboratory
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AgendaAgenda
Background (who? what? How?)
Lab TF 2.0: Profiles available for this 2008 connectathon
Ongoing work for next year and later
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Background: Who? What? How?Background: Who? What? How?
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Forces of IHE LABForces of IHE LAB
Contributing countries France, Japan, Italy, NL, Germany, UK, US, Belgium
Sponsors France: GMSIH, SFIL Japan: JAHIS, IHE-J US: RSNA
Technical & planning committee Cooperative work by email, and wiki 2 ftf meetings / year (June, December)
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General scope of LAB TF General scope of LAB TF 2008 2008
Ordering and performing clinical laboratory tests within acute care settings
Tests on in vitro specimens
Collected from human patients
Tests performed in lab as well as on the point of care
Microbiology included
Anatomic pathology excluded (another domain in IHE)
Sharing laboratory reports within a wide community of care providers
Report for one patient
Published in a document sharing infrastructure
Electronic document (human readable & importable in DB)
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LAB TF 2.0: Profiles for 2008 CATLAB TF 2.0: Profiles for 2008 CAT
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Organization of LAB TF rel 2.0Organization of LAB TF rel 2.0
Volume 1: use cases, profiles, actors, dependencies
Volume 2: Description of message-based transactions
Volume 3: Document-based transaction (lab report)
Volume 4: Common subset of LOINC test codes
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Lab TF Rel 2.OLab TF Rel 2.OW
orkflowW
orkflowIntra hospitalIntra hospital
Workflow
Workflow
Intra hospitalIntra hospital
Content
Content
Com
munit
Com
munit
yy
Content
Content
Com
munit
Com
munit
yy
Laboratory Testing Workflow - LTWLaboratory Device Automation - LDALaboratory Point Of Care Testing - LPOCTLaboratory Code Sets Distribution - LCSDLaboratory Barcode Labeling - LBL
Laboratory Testing Workflow - LTWLaboratory Device Automation - LDALaboratory Point Of Care Testing - LPOCTLaboratory Code Sets Distribution - LCSDLaboratory Barcode Labeling - LBL
Sharing Laboratory Reports - XD-LABSharing Laboratory Reports - XD-LAB
V3:V3:
CDACDAR2 R2
V2.5V2.5
HL7HL7
Su
bset o
f LOIN
C te
st cod
esS
ubse
t of LO
INC
test co
des
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Workflow profiles dependenciesWorkflow profiles dependencies
Laboratory
Order mgmt Automation
Care unitPatient admin.
Security
LTWLTW
LCSDLCSD
LPOCTLPOCT
LBLLBL
LDALDA
ATNAATNA
CTCT
PAMPAM
PDQPDQ
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Content profile dependenciesContent profile dependenciesLaboratory
Or Ambulatory EHR Or Hospital EMR
DocumentSharing
infrastructure
Security
Sharing Laboratory ReportsSharing Laboratory ReportsXD-LABXD-LAB
ATNAATNA
CTCT
XDSXDS
XDRXDR
XDMXDM
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Laboratory Testing Workflow (LTW) Laboratory Testing Workflow (LTW) & Laboratory Device Automation (LDA)& Laboratory Device Automation (LDA)
Order FillerOrder Placer
Order Result Tracker
Placer order
Filler order
ResultsResults Work order
LTW LDA
Work Order Steps
Query & download modes
AnalyzerPre/post
processor
Tests results
Automation Manager
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LDALDALTWLTW
Units of work in LTW & LDAUnits of work in LTW & LDA
Order Placer
Order FillerAutomation
ManagerLab Device
Laboratory Request = Order Group (ORC-4)
Placer Order (OBR-2)
Filler Order (OBR-3)
Work Order (OBR-2)
Work Order Step (OBR-2)
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Laboratory Point Of Care TestingLaboratory Point Of Care Testing
In vitro tests performed on point of care or patient bedside
specimen collected, tested at once and eliminated
No pre or post-processing
Results used immediately by the care provider
Supervision by a clinical laboratory of the hospital
Training the ward staff
Provides reagent & supervises QC
Clinical validation a posteriori
Scope:Scope:
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Benefits of LPOCTBenefits of LPOCT
Results obtained at once increases the efficiency of clinical decisions
Minimizes the blood quantity drawn from the patient, because of the immediate use of the specimen.
Preserving a high level of quality of the POCT process through its supervision by a clinical laboratory.
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Five major use casesFive major use cases
1. Observations to match with an existing order, real-time patient identity checking
2. Unordered observations, real-time patient identity checking
3. Unordered observations on a POC device with an intermittent link (no patient identity check)
4. Manual entry of unordered observations
5. QC results
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The Actors of LPOCTThe Actors of LPOCTPoint Of Care Result Generator (POCRG)
Produces the results from a specimen by testing on a specimen, or calculation or manual entry
Point Of Care Data Manager (POCDM)
Administers a set of POCRG, controls their process. Collects the patient and QC results. Forwards the patient results to the Order Filler
Order Filler
Recipient of POCT results. Stores the results within orders. Performs a posteriori clinical validation
Point of care results
Point of care patient results
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Ward
Clinical laboratory
LPOCT: Actors and TransactionsLPOCT: Actors and Transactions
Point Of Care Result Generator
Order Filler
Lab-32:
Accepted observation set
(patient results)
Lab-31:
Performed observation set
(patient or QC results)
Lab-30 (optional):
Initiate testing on a specimen
PAMPAM PDQPDQ
Point Of Care Data Manager
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One single option: Patient identity checkingOne single option: Patient identity checking
Transaction LAB-30 enables the operator to get a real time checking on the patient identity:
When initiating the test on the point of care device, the patient ID is scanned or keyed in. The device, then sends the patient ID, device ID, operator ID to the POCDM, which checks the patient identity and sends back the patient name, displayed on the device.
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Selected standard: POCT1-ASelected standard: POCT1-A
Point Of Care Result
Generator
Point Of Care Data Manager Order Filler
IHE Actor
POCT1-A Component
Point of care device
Observation Reviewer
Observation Recipient
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Correspondence IHE/POCT1-ACorrespondence IHE/POCT1-A
IHE is neutral towards the « Device Access Point » (DAP) interface.
IHE is an implementation guide of: The Device Message Layer (DML) interface, based on a proto-v3
HL7 XML message format The Observation Reporting Interface (ORI), which is a pure
subset of HL7 v2.5 (ORU message structures)
Added value : The « patient identiy checking » option.
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Sharing Laboratory Reports: XD-LABSharing Laboratory Reports: XD-LAB
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PurposePurpose
Sharing laboratory reports Access to lab results in a patient-centric manner Retrieval of historical lab results by providers of care To improve coordination of care
A content profile. A lab report: Presents a set of releasable laboratory results to be shared as
“historical information”. Is human-readable, shared between care providers of various
specialties and the patient (e.g. through a PHR) Contains machine importable coded data (decision support, bio-
surveillance)
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Value PropositionValue Proposition
Use case 1: Hospital lab report
Use case 2: Private lab report
Use case 3: Lab report shared by physician
Use case 4: Lab report automatically shared
Use case 5: Hospital’s cumulative report
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Structure of a CDA lab reportStructure of a CDA lab report
A laboratory report has its results sorted by “specialty” sections.
Within a specialty section, the results may be organized by “reported item” sections (battery, specimen study, individual test).
The relationship between reported item and specialty is not constrained: Left up to the Document Source Actor.
Each leaf section of the body is derived from a level 3 <entry>
18767-4: Blood gas18767-4: Blood gas
18719-5: Chemistry18719-5: Chemistry
Electrolytes
Na (mmol/l) 141
K (mmol/l) 4.4
Glucose (g/L) 0.5
Arterial blood gas
pO2 (mm Hg) 85
pCO2 (mm Hg) 35
HeaderHeader
Mandatory <entry>
Mandatory <entry>
Mandatory <entry>
B
O
D
Y
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Rendering of a single specimen battery (2)Rendering of a single specimen battery (2)
text block of the leaf section
<entry> <observationMedia> …
</observationMedia> </entry>
<renderMultimedia>
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A possible rendering for microbiologyA possible rendering for microbiology
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Ongoing work in LAB domainOngoing work in LAB domain
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Preparing LAB TF 2.1 Final Text Preparing LAB TF 2.1 Final Text July 2008 July 2008
Refine microbiology messaging Specimen attributes (collection site, method, location…) Dynamic tree of micro results (aligned with HL7 implementation
guide of Lab to EHR results message)
Add the public health lab report use case to XD-LAB Extend the scope to non-human specimen related to a human
patient Extend the number of CDA content modules (templates),
Minor corrections and clarifications (CPs)
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Preparation of supplementsPreparation of supplements
Lab to lab workflow
Linking images to lab results
Requester SubcontractorSub-order
Results
Next face to face meeting: New York, June 23-25Next face to face meeting: New York, June 23-25