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

2

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

30September, 2005 What IHE Delivers

Questions?Questions?

Francois.macary@agfa.comFrancois.macary@agfa.com