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1September, 2005 What IHE Delivers
IHE LaboratoryIHE Laboratory
François Macary, AGFA Healthcare François Macary, AGFA Healthcare
IHE Laboratory cochairIHE 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)
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
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
5
Sharing Laboratory Reports: XD*-LABSharing Laboratory Reports: XD*-LAB
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)
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 .
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:
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
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
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?
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?
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
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>
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
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
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>
18
A possible rendering for microbiologyA possible rendering for microbiology
19
Another possible rendering for microbiologyAnother possible rendering for microbiology
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…
21September, 2005 What IHE Delivers
Thank you.Thank you.
Questions…Questions…