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Point-of-Care Overview
GliwiceNovember 17th, 2008
POC Basics Connectivity System Components POC Interfaces Device Messaging Layer Observation Reporting Interface
Agenda
What is POS?
• Point-of-Care testing is defined as various testing conducted near the site of patient care.
• It incorporates different environments, including hospital based testing, near-patient testing, physician’s-office testing, and patient self testing.
POS Basics
POC Connectivity
• Allow seamless multi-vendor interoperability and communication between point-of-care devices, data concentrators, and clinical information systems.
• Provide framework for engineers to design devices, workstations and interface for multiple types and brands of POC devices to communicate bi-directionally with access points, data concentrators, and laboratory information systems from variety of vendors.
POS Basics
What is POC Standard?
• The core of the standard is a group of specifications developed by the Connectivity Industry Consortium (CIC).
• Describes the attributes of an access point; the communication protocols between the device and access point; communication between a data manager and clinical information system.
POS Basics
Evolution of POC standards
Cooperative effort of: providers, manufacturers, representatives of:
• CIC• NCCLS• HL7• IEEE• CAP• FDA• JCCLS• IFCC
POS Basics
POC Basics Connectivity System Components POC Interfaces Device Messaging Layer Observation Reporting Interface
Agenda
Point-of-Care Device• Hand-held devices; test modules that are part of the
other instrumentation (patient monitor, for example); or small, bench-top analyzers
Connectivity System Components
Access Point• Allow to communicate with an Observation Reviewer to
report results and exchange information
Connectivity System Components
The Observation Reviewer (POC Data Manager)
• The primary role of an Observation Reviewer is to host one or more services to which point-of-care diagnostic devices connect.
• Services hosted by an Observation Reviewer may exchange data with existing information systems that already exist in the hospital laboratory
Connectivity System Components
The Observation Recipient (LIS, CDR, or EMR)• In many cases, the final resting place of a point-of-care
diagnostic test observation is inside an Observation Recipient system
• Typically, LIS or Clinical Data Repository (CDR) systems fill the role of Observation Recipient
Connectivity System Components
Device Interface• Governs the flow of information between devices and
Observation Reviewers
Observation Reporting Interface (EDI interface)
• Describes messaging between Observation Reviewers and Observation Recipients
Connectivity System Components
POC Basics Connectivity System Components POC Interfaces Device Messaging Layer Observation Reporting Interface
Agenda
DML• Device Messaging Layer specification describes the dialog
between a device and Observation Reviewer
POS Interfaces
The DML allows bidirectional data exchange concerning the following topics:I.Device Status
II.Observations
1. Patient Tests
2. Calibration Tests
3. Quality Tests
i. Liquid QC
ii. Electronic QC
iii. Calibration Verification
iv. Proficiency Test
III.Device Events
IV.Update Lists
1. Operator List
2. Patient List
V.Directives
1. Basic (e.g., Lockout, Goto Standby)
2. Complex (e.g., Set Time)
3. Vendor-specific
VI.Vendor-specific Data
POS Interfaces
DAP• Device Access Point specification defines a law cost, flexible
means to reliably communicate messages between POC Device and Observation Reviewer
POS Interfaces
DAP and DML interfaces are layered on top one another in the OSI model
POS Interfaces
DML
DAP
• Observation Reporting Interface – facilities the communication of test results and orders information between Observation Reviewers and Observation Recipients
• The interface provides bidirectional flow between these services
POS Interfaces
POC Basics Connectivity System Components POC Interfaces Device Messaging Layer Observation Reporting Interface
Agenda
Message Flow•In general, the communication between the Device and Observation Reviewer can be described at a high – level in terms of dialog between two actors•Example: Scheme of base profile message flow
Device Messaging Layer
Message Encoding•POC Device Messaging Layer’s messages leverage the XML encoding rules defined in HL7 version 3•Example: Simple Glucose Messages
Device Messaging Layer
Message Encoding
Device Messaging Layer
POC Basics Connectivity System Components POC Interfaces Device Messaging Layer Observation Reporting Interface
Agenda
• EDI employs existing HL7 messages, segments, and fields in order to communicate test results and ordering information
• Four new triggers (as compared to HL7 v2.4) are defined for HL7 ORU message
• As long as the final implementation uses the messages and fields defined in POCT1 specification (ORU^R30, ORU^R31, ORU^R32, ACK^R33), the resulting interface is compliant with the POCT1 Observation Reporting Interface specification
Observation Reporting Interface
• Individual institutions or deployments may have additional requirements beyond addressed by POCT1 specification
• Message fields not defined for use by POCT1 specification may be used to support these site-specific requirements
Observation Reporting Interface
Message Example• Sample message exchange, preordered test with single-
valued result• ORU^32 – Observation result message from POCT1DMS-
OBSREV to POCT1LIS-OBSRCPT sent 6/10/00 1:03:55
Observation Reporting Interface
ORU^30Unordered Observation – Place Order
• One example of this use case occurs when a doctor verbally instructs a nurse to perform a test
• To allow the Observation Reviewers correlate every result with its associated order, the Observation Recipient will return the newly created Order ID in the application-level acknowledgement to this ORU^30 message
Observation Reporting Interface
ORU^31New Observation – Search for an Order
• In this case, the Observation Reviewers does not know if an order has been placed
• This trigger instructs the Observation Recipient to search for an existing order for the associated results
Observation Reporting Interface
ORU^32Preordered Observation
• In this case order information is provided by either of the following schemes:
The user enters an accession number at the POC Device when performing test
If the Device doesn’t support that input capability or the accession number isn’t known at the point-of-care, the Observation Reviewer (e.g., POC Data Manager) retrospectively determines the appropriate order to match to the test result
Observation Reporting Interface
Many thanks for your attention!
Iwona Machowska Iwona Machowska
Marketing & New Business ManagerTel. +48 600 375 376Email: [email protected]
Ul. Toszecka 101/222Ul. Toszecka 101/22244-100 Gliwice, Poland44-100 Gliwice, Poland
Tel. 48 32 23 00 290Tel. 48 32 23 00 290www.codeconcept.plwww.codeconcept.pl