NPEx USER GROUP 2017 · 2020-04-22 · –Is this approach workable? –Has anyone used/seen...
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NPEx USER GROUP 2017
Transcript of NPEx USER GROUP 2017 · 2020-04-22 · –Is this approach workable? –Has anyone used/seen...
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
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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
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2015’s proposal - verification
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Domain model (simplified)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540481/
CDC model:
Single Order
Multiple Specimens
Multiple Cultures
Multiple Isolates
Multiple Sensitivities
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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
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HL7 2.5.1 Ch7, Observations
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ASL/ARL in Telepath & APEX
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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
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• 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?
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* 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
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HL7 2.8.2 Ch2A, DataTypes
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OBX 4, ‘original’ mode
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OBX 4, ‘enhanced’ mode
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Genomics
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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
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Dicom/ HL7 CDA work
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More Hierarchies!
Reporting Guidelines for Clinical Laboratory Reports in
Surgical Pathology, 2008, Goldsmith et al
Questions?/Discussion?
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