Transactions

sumo.irisa.fr

Transactions

Laboratory Scheduled Workflow

Comments on Volume 2

Transactions

François Macary

Hexaflux – groupe europMedica

Connectathon Workshop, Padova, 02-03 february 2004


Summary

• Choice of the standard

• HL7 profiling conventions

• Message granularity and acknowledgements

• Network guidelines

• Order group, placer, filler and work order

• The need for transaction LAB-2

• Technical and clinical validation

• Transitions and correlations of statuses

• Result management

• Specimen management

• Particular notice on some segments

• Real world use cases

• Change proposal management

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 2


Choice of the standard

• Need for a fully implementable version with guides and

tools ready for use

– Excluded HL7 v3

• Supporting specimen and container management

– Excluded v2.3.1 and v2.4

• Choice of HL7 v2.5, released a while before IHE Lab TF

HL7 v2.5

HL7 v2.3.1

Transactions LAB-1, LAB-2, LAB-3, LAB-4, LAB-5

Transactions RAD-1, RAD-12

Pipe encoding shall be supported. XML encoding may be supported

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 3


HL7 v2.5 profiling conventions

• Static definition: Usage and cardinalities

– Usage R: Required

– Usage RE: Required but may be empty

– Usage O: Optional = Usage not defined yet

– Usage C: Conditional (condition predicate)

– Usage X: Not supported. Must not be sent.

See section 2.2

See section 2.2

For a better readability segments with usage X do not appear in message tables

For a better readability fields with usage O do not appear in segment tables

Two doublequotes = explicit null value for the field. The receiver must remove

the corresponding data in its database

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 4


Message granularity and

acknowledgement

See section 2.3

See section 2.3

• HL7 original acknowledgement mode

– one single acknnowledgement per message

Transactions LAB-1 through LAB-5 use:

– OML acknowledged by ORL

– OUL acknowledged by ACK

• Granularity

– A message in LAB-1 or LAB-3 = 1 placer order or 1 order group

– A message in LAB-2 = 1 filler order (and possibly 1 order group)

– A message in LAB-4 or LAB-5 = 1 work order order

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 5


Network guidelines

See section 2.3.1

See section 2.3.1

Une Minimal Lower Layer Protocol defined in appendix C of the HL7 Implementation Guide

Trigger

event

Actor

application

Actor

application

Initiates network

connection

Sends block

Waits for the

answer

Message

OML or OUL

Initiating

module

Acknowledgement

message

answer

Message

OML or OUL

Accepting

module

Acknowledgement

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 6


Network for transaction LAB-1

LAB-1 is the only transaction dealing with trigger events on both sides

Trigger

event

New order

entered

Status

change

Trigger

event

Order Placer

Order Filler

OML^NW

OML^NW

OML^SC

Initiating

module

OML^NW

Accepting

module

OML^SC

Accepting

module

OML^SC

Initiating

module

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 7


Order group, placer order, , filler order, work order

Care Unit

Order Placer

LAB-1:

Order group & placer

order Management

LAB-2:

New filler orders

standalone or related

to an existing order

group

Laboratory

LAB-4:

Work Orders

Order Filler

LAB-5:

Results of

Work Orders

Order Result Tracker

LAB-3: Results of

placer orders within

order groups

Automation Manager

Robotic devices

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 8


The need for transaction LAB-2

Order Placer

Order Filler

An order group

placer order P1

placer order P2

placer order P3

LAB-1: OML^O21 (NW)

LAB-1: OML^O21 (NW)

LAB-2: OML^O21 (SN)

ORL^O21 (NA) : P3

filler order F2

Filler order F3

filler order F1

Must have the same vision

Order Result Tracker

order group

Through LAB-3

P1

P2

P3

See See microbiology

microbiology

use use case case in in section section

9.5.3.6 9.5.3.6

LAB-4

work order W3 work order W1

work order W2

Automation Manager

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 9


Technical and clinical validation of the results

Order Placer

Order Result Tracker

See See Glucose Glucose study study

use use case case in in section section

9.3.3.7 9.3.3.7 and and

9.3.3.14 9.3.3.14

LAB-1

Results clinically validated:

OBR-25 = P, F or C

OBR-32 = result interpreter + date

See See Glucose Glucose study study

use use case case in in section section

9.3.3.6 9.3.3.6 and and

9.3.3.13 9.3.3.13

LAB-3

Results clinically validated:

OBR-25 = P, F or C

OBR-32 = result interpreter + date

OBX-11 = F or C

Order Filler

Clinical

validation

LAB-5

Results technically validated:

OBR-25 = P, F or C

OBR-32 = result interpreter + date

OBX-11 = F or C

Technical

validation

See See Glucose Glucose study study

use use case case in in section section

9.3.3.5 9.3.3.5

Automation Manager

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 10


Transitions of status: : ORC

ORC-5: Order status

SC

IP

A

CM

See See section section 3.7, 3.7,

3.12.1 3.12.1 and and

3.12.2.1 3.12.2.1

CA

SC: In process, scheduled, specimen may not be available yet

IP: In process, specimen available in laboratory

A: Some but not all results available

CM: Order is completed

CA: Order canceled (at any stage of the process)

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 11


Transitions of status: : OBR

OBR-25: Order Result Status

O

I

S

R

P

F

C

See See section section

3.12.2.2 3.12.2.2

X

O: Order received. Specimen not yet received

S: In process, scheduled, specimen may not be available yet

I: Specimen available, results pending, procedure incomplete

R: Some results available, not verified, i.e. not technically (LAB-5) or clinically (LAB-3) validated

P: Preliminary (partial) results verified, i.e. technically (LAB-5) or clinically (LAB-3) validated

F: Final results verified, i.e. technically (LAB-5) or clinically (LAB-3) validated

C: Correction after final results. Results still final and verified.

X: Order canceled (at any stage of the process)

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 12


Transitions of status: : OBX

OBX-11: Observation Result Status

O

I

R

P

F

C

See See section section

3.11, 3.11, 3.12.2.3 3.12.2.3

X

D

O: Order detail description only. No result

I: Specimen in lab, results pending

R: Result entered, not verified, i.e. not technically (LAB-5) or clinically (LAB-3) validated

P: Preliminary (partial) result verified, i.e. technically (LAB-5) or clinically (LAB-3) validated

F: Final result verified, i.e. technically (LAB-5) or clinically (LAB-3) validated

C: Correction after final result. Result still final and verified.

X: Result cannot be obtained for this observation

D: Deletes the OBX record

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 13


Relationship between the

three status fields

The order result status as contained in the OBR-25 field cannot be “more

finalized” than the “lowest” status of any of the related individual tests (as

contained in OBX-11)

The status of the order as defined by the Order Fulfiller in ORC-5 cannot be

“higher/more finalized” than the status of the related request (as contained in

OBR-25)

Cancellations (‘X’ or ‘D’ statuses) are left apart when applying the rules above

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 14


Results management in LAB-3

Recapitulative mode

the order in which the OBX segments appear defines the

sorting order for the presentation of the results. In this

respect, the Order Filler shall transmit all available results in

recapitulative mode whether they have already been

transmitted or not

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 15


Specimen management in

LAB-1

• Battery centric: OML^O21 / ORL^O22

– Example: glucose study use case - 9.3.3.1

– Example: creatinine clearance use case - 9.4.3.1

• Specimen centric: OML^O33 / ORL^O34

– Example: hematology use case – 9.2.3.1

• Container centric: OML^O35 / ORL^O36

– No example in volume 2

Order Placer side: Not all specimen

collected

OBR-11 « Specimen Action Code » from

HL7 table 0065

‘P’ à specimen pending.

‘S’ à all specimen provided

‘L’ à Lab to collect the specimen

Order Filler side: Specimen missing or rejected

SPM-20 « Specimen availability = ‘N’

SPM-21 « Specimen Reject Reason from HL7

table 0490

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 16


Particular notice on some segments

• One single TQ1 à Priority {S, A, R, P, C, T}

– One single execution per order

• NTE: Notes and comments

– Only below OBR and OBX

– Comment source

– Comment type : I = Internal, C = medical staff, P = patient

– One comment of one type = One segment NTE

• All clinical observations carried in OBX segments

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 17


Real world use cases

For For implementers: One One of of the the most most helpful helpful parts parts of of Laboratory Technical

Framework. See Seesection 9. 9.

All All built built on on the the same same template:

1) 1) storyboard, 2) 2) human human actors actors and and organizations, 3) 3) Ids Ids and and numbers, 4) 4)

interactions list, list, 5) 5) interaction diagram, 6) 6) messages with with key key information

highlighted.

• 9.2 : 2 hematology batteries on blood specimen unidentified

• 9.3 : Glucose tolerance study (1 battery, 5 specimens)

• 9.4 : Creatinine clearance (1 battery, 2 specimens)

• 9.5 : Microbiology : 2 specimens & 3 germs

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 18


Change Proposal management

• Fill in the template document for change proposal on a IHE TF in

« trial for implementation » version

• Mail it to Karima.bourquard@gmsih.fr or fmacary@hexaflux.com

• Decision: Periodically, by the Lab Technical Committee

• First CP: Precision on data type XON (changed in v2.5), used by

ORC-21(Ordering Facility Name). Use components 1, 7 and 10.

– Example: Urology^^^^^^FI^^^UR01

Connect-a-thon Workshop, Padova, 02-03 february 2004 slide 19


Thank you for your attention

Questions

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