21
1 September, 2005 What IHE Delivers IHE Laboratory IHE Laboratory François Macary, AGFA Healthcare François Macary, AGFA Healthcare IHE Laboratory IHE Laboratory cochair cochair

September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

Embed Size (px)

Citation preview

Page 1: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

1September, 2005 What IHE Delivers

IHE LaboratoryIHE Laboratory

François Macary, AGFA Healthcare François Macary, AGFA Healthcare

IHE Laboratory cochairIHE Laboratory cochair

Page 2: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

2

Laboratory Technical FrameworkLaboratory Technical Framework

General scope:

Ordering and performing clinical laboratory tests.

In vitro testing

Microbiology included.

Anatomic pathology excluded.

Sharing of laboratory reports (both ambulatory & acute

care settings)

Page 3: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

3

Primary membership (sponsors & contributors)Primary membership (sponsors & contributors)

Biomedical scientists in professional societies SFIL (Fr) In discussion: CAP (US)

National Healthcare IT bodies GMSIH (Fr) JAHIS (Jp) HIMSS (US) In discussion: CHCF (US)

Contributing countries: France, Japan, Italy, UK, Germany, US Basically LIS & AM vendors, Analyzers manufacturers

Page 4: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

4

Summary of integration profilesSummary of integration profiles

Workflow Integration Profiles: Laboratory Scheduled Workflow (LSWF) Laboratory Information Reconciliation (LIR) Laboratory Device Automation (LDA) Laboratory Point Of Care Testing (LPOCT) Laboratory Code Sets Distribution (LCSD) Laboratory Specimen Label Workflow (LSL)

Content Integration Profiles Sharing Laboratory Reports (XD*-LAB)

20072007

HL7 HL7 v2.5v2.5

+ POCT1-A+ POCT1-A

HL7 v3HL7 v3CDA R2CDA R2

20062006

Page 5: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

5

Sharing Laboratory Reports: XD*-LABSharing Laboratory Reports: XD*-LAB

Page 6: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

6

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 readable coded entries (decision support, bio-

surveillance)

Page 7: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

7

Value PropositionValue Proposition

Use case 1: Hospital lab report [CIS RHIO EHRs] Most significant lab reports shared at discharge time.

Use case 2: Private lab report [LIS RHIO / PHR] Final report shared by a private laboratory

Use case 3: Lab report shared by physician [EHR PHR] Results received from a reference laboratory. Report shared by physician.

Use case 4: Lab report automatically shared [LIS RHIO] A laboratory, systematically and automatically shares its final reports with a

regional healthcare network.

Use case 5: Hospital’s cumulative report [CIS RHIO] At discharge time a hospital physician selects the most significant lab

results and builds a cumulative report shared in a health info exchange .

Page 8: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

8

CDA Release 2 from HL7 v3 normative edition

HL7 V3 Laboratory Result Event RMIM

<entry> template based on a restriction of LAB “Result Event” RMIM.

LOINC subset of test codes, alternatively SNOMED CT

XDS (Cross Enterprise Document Sharing)

XDR (Cross Enterprise Document Reliable Interchange)

XDM (Cross Enterprise Document Media Interchange)

DGS (Digital Signature)

NAV (Notification of Document Availability)

Leverages: Leverages:

Restrains: Restrains:

Page 9: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

9

A CDA document is a kind of XML document A CDA document is a kind of XML document

Header: <ClinicalDocument>Header: <ClinicalDocument>

Body: <structuredBody>Body: <structuredBody>

<section>

ObservationSubstance administrationRegion of interestProcedureEncounterOrganizer

Observation multi-media

<section><text>Human reader

<entry>

machine

<section>

<section>

<section>

Entries contain Entries contain structured and coded structured and coded data to be integrated in data to be integrated in the reader’s systemthe reader’s system

Page 10: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

10

clinicalDocument/code Multi-disciplinary lab report (LOINC or SNOMED) Single discipline lab report (e.g. chemistry) (LOINC)

recordTarget The patient

effectiveTime Time the report was issued

confidentialityCode Normal, restricted, very restricted interpreted by defined policies

What kind of What kind of report?report?

Who is the Who is the patient?patient?

When was When was the report the report produced?produced?

Lab contextual data in the Lab contextual data in the headerheader (1)(1)

Level of Level of confidentialityconfidentiality

Page 11: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

11

Lab contextual data in the Lab contextual data in the header header (2)(2)

author

A human (e.g. a physician) A system (e.g. LIS, EHR, …)

custodian

The organization operating the Content Creator

legalAuthenticator

The verifier of the report who legally authenticated it

authenticator

A verifier who is not he legal authenticator

Author of the Author of the reportreport

Who assumes Who assumes stewardship?stewardship?

Who signed Who signed the report?the report?

Who verified Who verified the report?the report?

Page 12: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

12

Lab contextual data in the Lab contextual data in the header header (3)(3)

inFulfillmentOf/order

the Order (Group) that was fulfilled

participant typecode=“REF”

The ordering physician for the lab act.

documentationOf/serviceEvent

The act documented

serviceEvent/statusCode

“active” = preliminary, “completed” = final

serviceEvent/performer

The fulfiller lab (person and organization)

Who ordered Who ordered the acts?the acts?

In fulfillment of In fulfillment of what order?what order?

Which lab Which lab performed the performed the tests?tests?

What act?What act?

Preliminary or Preliminary or final report?final report?

Page 13: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

13

Human-readable body: Two levels of sectionsHuman-readable body: Two levels of sections

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

Page 14: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

14

A specialty section may also be itself a leaf section…A specialty section may also be itself a leaf section…

18725-2 MICROBIOLOGY STUDIES18725-2 MICROBIOLOGY STUDIES

Urine studyDirect examination

Origin: mid-stramColor: strawAppearance: clear

MicroscopyLeukocyes: 500 /mL

HeaderHeader

<entry>

……According to the According to the choice of the choice of the Document Source Document Source Actor.Actor.

B

O

D

Y

18719-5: Chemistry18719-5: Chemistry

Glucose (g/L) 0.5

<entry>

Page 15: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

15

Lab report structureLab report structure

Header Common + realm Spec.Header Common + realm Spec.

Leaf Leaf section section templatetemplate“Single “Single

specimen specimen battery”battery”

Top level “specialty” section templateTop level “specialty” section template

CDACDAL3L3

CDACDAL2L2

CDA L1CDA L1

Leaf Leaf sectionsection

templatetemplate“Individual “Individual

test”test”

Leaf Leaf sectionsection

templatetemplate“Challenge “Challenge

study study (DFT)”(DFT)”

Leaf Leaf sectionsection

templatetemplate“Microbio-“Microbio-logy study”logy study”

Source or Realm Spec.

<entry> template

Page 16: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

16

Rendering of a single specimen battery (1)Rendering of a single specimen battery (1)

text block of the leaf section

The current result from the current order

(in documentationOf/serviceEvent)

Some previous results

Specialty Specialty sectionsection

Page 17: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

17

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>

Page 18: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

18

A possible rendering for microbiologyA possible rendering for microbiology

Page 19: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

19

Another possible rendering for microbiologyAnother possible rendering for microbiology

Page 20: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

20

LOINC subset for test codesLOINC subset for test codes

Chemistry …………………………………………………………….

Hematology ……………………………………………………….....

Toxicology and drug monitoring ………………………………..

Virology and serology ……………………………………………..

Parasitology and micology ………………….……………………

Bacteriology …………………………………………………………

Immunology and cell mark ………………………………………..

Patient and specimen findings …………………………………..

873 tests

284 tests

194 tests

374 tests

158 tests

387 tests

278 tests

30 measures

Alternatively other terminologies may be used: Alternatively other terminologies may be used: SNOMED CT, national vocabs…SNOMED CT, national vocabs…

Page 21: September, 2005What IHE Delivers 1 IHE Laboratory François Macary, AGFA Healthcare IHE Laboratory cochair IHE Laboratory cochair

21September, 2005 What IHE Delivers

Thank you.Thank you.

Questions…Questions…