View
217
Download
2
Category
Tags:
Preview:
Citation preview
Clinical Laboratory DomainNew Integration Profiles
Clinical Laboratory DomainNew Integration Profiles
Charles ParisotCharles ParisotGE HealthcareGE Healthcare
IHE IT Technical Committee Co-chairIHE IT Technical Committee Co-chair
François MacaryFrançois MacaryAGFA Healthcare ITAGFA Healthcare IT
IHE Laboratory Committee Co-chairIHE Laboratory Committee Co-chair
IHE Lab today and to-morrow
• Five profiles:– Laboratory Scheduled Workflow (LSWF)– Laboratory Information Reconciliation (LIR)– Laboratory Point Of Care Testing (LPOCT)– Laboratory Device Automation (LDA)– Laboratory Code Set Distribution (LCSD)
• Future plans– Incorporate analyzer images in the result workflow– Cross-enterprise sharing of lab reports, using CDA-R2– Specimen labels workflow
• Ordering, placing, scheduling and performing clinical laboratory tests both for Hospital and Ambulatory.
• Microbiology included. Anatomic pathology and blood bank excluded
Laboratory Information Reconciliation
• Match clinical lab observations produced on specimens collected from misidentified or unidentified patient with the patient’s record.
• Match clinical lab observations produced on specimens with orders created afterwards, either in the Order Placer or in the Order Filler application.
• LIR profile depends upon LSWF and LDA profiles
1. Unidentified Patient registered at ADT. Clinical lab tests ordered at Order Placer level.
2. Unidentified Patient registered at ADT . Clinical lab tests ordered at Order Filler level.
3. Unidentified Patient registered at Order Placer. Clinical lab tests ordered at Order Placer level.
4. Unidentified Patient registered at Order Filler. Clinical lab tests ordered at Order Filler level.
Laboratory Information ReconciliationUse Cases 1, 2, 3, 4
The Unidentified Patient cases cover scenarios in which the care situation requires that tests be ordered immediately, even before proper Patient registration. It also covers the scenario of tests performed before the order is entered, whether the patient is identified or not.
5. Clinical lab tests performed on laboratory automation before creation of the order. The order is created automatically from the results.
The order is created afterwards at Order Filler and matched to the results.
Laboratory Information ReconciliationUse Case 5
LIR also covers the scenario of tests performed before the order is entered, no matter the patient is identified or not.
IHE Lab today and to-morrow
• Five profiles:– Laboratory Scheduled Workflow (LSWF)– Laboratory Information Reconciliation (LIR)– Laboratory Device Automation (LDA)– Laboratory Point Of Care Testing (LPOCT)– Laboratory Code Set Distribution (LCSD)
• Future plans– Incorporate analyzer images in the result workflow– Cross-enterprise sharing of lab reports, using CDA-R2– Specimen labels workflow
• Ordering, placing, scheduling and performing clinical laboratory tests both for Hospital and Ambulatory.
• Microbiology included. Anatomic pathology and blood bank excluded
Laboratory Device Automation (LDA)
Order FillerOrder Placer
Order Result Tracker
ADT
Placer order
Filler order
Demographics
Results
Demographics
Results Work order
LSWF LDA
Work Order Steps
Automation Manager
Clinical Laboratory
Scope of LDA Integration Profile
• Workflow between an Automation Manager and the automated devices that it handles.
• Workflow specimen based: A sequence of steps, each of which uses a specimen on a device.
• Scope limited to devices operated by the lab staff.
• Goal: To fulfill a Work Order and its clinical tests on the related specimens, using the various devices connected to the Automation Manager.
• Except for the robotic transportation of the specimen, this profile does not address electromechanical command interface. Its transactions carry the needed or produced specimen related data back and forth between Automation Manager and Devices
Fulfillment of a Work Order
• A Work Order is split into a sequence of steps according to the devices involved in its process. This sequence of steps includes three main phases: – the pre-analytical process of the specimens (sorting,
centrifugation, aliquoting, transportation, decapping)
– the analytical process (run of the clinical tests on the specimen)
– the post-analytical process (recapping, transportation, rerun, dilution, storage and retrieval).
Example of workflow
Automation Manager
Robotic Specimen Transportation System
decapper
Step 2: decap Chemistry Analyzer
Step 3: Convey to chemistry analyzer
centrifuging
Test Na, K, Cl
Perform electrolye Work Order for serum n° 123
Step 4: Query for test?
Schedules steps 1 to 6
Downloads steps 1, 2, 3, 5, 6
Schedules steps 1 to 6
Downloads steps 1, 2, 3, 5, 6
Send the results
Step 1: Convey to decapper
recapper
Step 6: recap
Step 5: Convey to recapper
Blood specimen
Serum
LAB-22 Query for
WOS
LAB-26 SWOS status
change
LAB-21 WOS
download
LAB-22 Query
for WOS
LAB-23 AWOS status
change
LAB-21 WOS
download
Pre/Post-processor Analyzer
Automation Manager
LDA: Actors & Transactions
• WOS = Work Order Step– AWOS = Analytical Work Order Step: Produces observations– SWOS = Specimen processing Work Order Step. Does not produce any observation
LDA: Actors and transactions
Actors Transactions Opt HL7 2.5 messagesAutomationManager
LAB-21 : WOS Download R OML^O33 / ORL^O34
LAB-22 : WOS Query R QBP^Q11 / RSP^K11
LAB-23 : AWOS Status Change
R OUL^R22 / ACK^R22
LAB-26 : SWOS Status Change O SSU^U03 / ACK^U03
Analyzer LAB-21 : WOS Download O OML^O33 / ORL^O34
LAB-22 : WOS Query O QBP^Q11 / RSP^K11
LAB-23 : AWOS Status Change R OUL^R22 / ACK^R22
Pre/PostProcessor
LAB-21 : WOS Download O OML^O33 / ORL^O34
LAB-22 : WOS Query O QBP^Q11 / RSP^K11
LAB-26 : SWOS Status Change R SSU^U03 / ACK^U03
LDA: Options
Actor Options
Automation Manager Management of Pre/Post-processor
Analyzer Query mode WOS
Download mode WOS
Pre/Post-processor Query mode WOS
Download mode WOS
IHE Lab today and to-morrow
• Five profiles:– Laboratory Scheduled Workflow (LSWF)– Laboratory Information Reconciliation (LIR)– Laboratory Device Automation (LDA)– Laboratory Point Of Care Testing (LPOCT)– Laboratory Code Set Distribution (LCSD)
• Future plans– Incorporate analyzer images in the result workflow– Cross-enterprise sharing of lab reports, using CDA-R2– Specimen labels workflow
• Ordering, placing, scheduling and performing clinical laboratory tests both for Hospital and Ambulatory.
• Microbiology included. Anatomic pathology and blood bank excluded
Scope of LPOCT
• Tests of clinical biology, performed on point of care or patient
bedside
– In vitro tests: performed on a specimen, not on the patient itself
– Usually quick tests, specimen collected, tested at once and eliminated
– No pre or post-processing (like in LDA)
– Results used immediately by the care provider in its clinical decisions
• Supervision by a clinical laboratory of the healthcare enterprise
– Training provided to the ward staff good practices on specimen and
analyzer
– Provision of reagent
– Supervision of quality control
– Clinical validation a posteriori
Contraints and benefitsof point of care testing
• 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. E.g. Two drops are enough to test blood gas, electrolyte and hematocrit of a new-born baby.
• Preserving a high level of quality of the POCT process requires its supervision by a clinical laboratory.
Examples of LPOCT
• Portable blood gaz and chemistry analyzer used by the nurse on patient bedside
• Blood gas analyzer permanently installed in a surgery theater
• Coagulation analyzer in acute care ward• Glucometer used by the patient in home care• Work station on which the nurse manually
enters the results of pregnancy stick tests.
The IHE actors of LPOCT
Point Of Care Result Generator (POCRG)Produces the results from a specimen
• By measurement of an analyte on a specimen
• By calculation
• By manual entryPoint Of Care Data Manager (POCDM)
Handles and administers a set of POCRG• Controls the process,
• checks the patient identity and location
• Collects the patient results
• Collects and manages the QC results
• Forwards the patient results to the Order Filler
The IHE actors of LPOCT
Order FillerRecipient of POCT results
• Stores the results within matched or generated orders
• Performs the clinical validation
Ward
Clinical laboratory
LPOCT: Actors and Transactions
Point Of Care Result Generator
Point Of Care Data Manager
Order Filler
Lab-32:
Accepted observation set
Lab-31:
Performed observation set
Lab-30: (option persistent cnx)
Initiate testing on a specimen
POCDM is assumed to be provided with up-to-date patient demographics and visit data, using an appropriate profile (PAM or PDQ)
LPOCT depends upon LSWF: The Order Filler is also involved in LSWF profile.
Transactions and optionsActors Transactions Optionality
Order Filler Transaction LAB-32 R
Point Of Care Data Manager
Transaction LAB-30 O
Transaction LAB-31 R
Transaction LAB-32 R
Point Of Care Result Generator
Transaction LAB-30 O
Transaction LAB-31 R
Transaction LAB-30 is required with option “Patient Identity Checking”
Selected standards
POCRG POCDM Order Filler
Based on HL7 v2.5
Based on HL7 early v3
POCT 1-A, published by CLSI (ex NCCLS)
IHE Lab today and to-morrow
• Five profiles:– Laboratory Scheduled Workflow (LSWF)– Laboratory Information Reconciliation (LIR)– Laboratory Device Automation (LDA)– Laboratory Point Of Care Testing (LPOCT)– Laboratory Code Set Distribution (LCSD)
• Future plans– Incorporate analyzer images in the result workflow– Cross-enterprise sharing of lab reports, using CDA-R2– Specimen labels workflow
• Ordering, placing, scheduling and performing clinical laboratory tests both for Hospital and Ambulatory.
• Microbiology included. Anatomic pathology and blood bank excluded
Laboratory Code Set Distribution
• The goal of this profile is to simplify the configuration of the systems involved in the Laboratory Scheduled Workflow.
• The Laboratory Code Set Distribution Profile offers the means to share the same set of test/observation codes between different actors.
• Other information can be also exchanged like presentation of results, laboratory codes (in which lab a test is performed), units …
Laboratory Code Set Distribution Actors/Transaction
Laboratory Code Set Master
LAB-51: Laboratory Code Set Management
Laboratory Code Set Consumer
Grouped with: Order FillerEnterprise Common Repository…
Grouped with: Order PlacerOrder Result TrackerAutomation ManagerOrder Filler…
Replaces Observation/Test/Battery Code SetsReplaces Observation/Test/Battery Code Sets
All Observation, Test and Battery code sets of the Consumer are replaced by the code sets sent by the Master. This Use Case is used both for initialization as well as periodic (weekly, monthly) update.
Laboratory Code Set Distribution Use Case 1
Laboratory Code Set Master
Laboratory Code Set Consumer
Creates observation-test -battery codes
Laboratory Code Set Management (REP)
Laboratory Code Set Distribution Standard
Interactions based on HL7 V2.5, Master Files (chapter 8).
Advantages of using HL7 V2.5:
• HL7 is already implemented on laboratory systems; no need to implement a new protocol• Master Files are already adopted by some vendors.• Messages are rich enough to transport other information than just observation/test/battery codes :
• presentation of the results• laboratory codes• units of measure
HL7 Master Files
Master files are a set of common reference files used by one or more application systems. Some common examples of master files in the healthcare environment include:
• staff and health practitioner master file• location (census and clinic) master file• lab test definition file• exam code (lab, radiology) definition file
Recommended