1 September, 2005 What IHE Delivers HIMSS 2006 – Interoperability HIMSS 2006 – Interoperability Showcase Showcase François Macary, AGFA HCES François Macary, AGFA HCES IHE Lab Committee co-chair IHE Lab Committee co-chair IHE Clinical IHE Clinical Laboratory Update Laboratory Update
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September, 2005What IHE Delivers 1 HIMSS 2006 – Interoperability Showcase François Macary, AGFA HCES IHE Lab Committee co-chair IHE Clinical Laboratory.
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ASTM E1394ASTM E1394+ one future + one future ISO standardISO standard
IHE proposed one IHE proposed one common standard: common standard: HL7 2.5 – chap 13HL7 2.5 – chap 13
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Laboratory Information Reconciliation (LIR)Laboratory Information Reconciliation (LIR)
Reconcile clinical lab observations produced on specimens collected from misidentified or unidentified patient. (Same thing as PIR in Radio land)
Reconcile clinical lab observations produced on specimens before the orders are created: Results for unknown orders. (Different from PIR)
LIR profile depends upon LSWF and LDA profiles
No added transactions
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LIR: one example of process flowLIR: one example of process flow
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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 provided to the ward staff
Provision of reagent
Supervision of quality control
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. E.g. Two drops are enough to test blood gas, electrolyte and hematocrit of a new-born baby.
Preserving a high level of quality of the POCT process through its supervision by a clinical laboratory.
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Examples of LPOCTExamples of LPOCT
Portable blood gaz and chemistry analyzer used by the nurse in a neonatology ward
Blood gas analyzer permanently installed in the surgery theater
Glucometer used by the patient in home care
Workstation on which the nurse manually enters the results of pregnancy stick tests.
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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
Point Of Care Data Manager
Order Filler
Lab-32:
Accepted observation set
(patient results)
Lab-31:
Performed observation set
(patient or QC results)
Lab-30:
Initiate testing on a specimen
POCDM and Order Filler are assumed to be provided with up-to-date patient demographic data
(for instance by PAM or PDQ)
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Five major use casesFive major use cases
1. Observations to match with an existing order, real-time patient identity checking
3. Unordered observations on a POCRG with an intermittent link (no patient identity check)
4. Manual entry of unordered observations
5. QC results
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Selected standardSelected standard
POCRG POCDM Order Filler
HL7 v2.5Based on HL7 early v3 in XML
POCT 1-A, published by CLSI (ex NCCLS)
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Laboratory Code Set DistributionLaboratory Code Set Distribution
The goal of this profile is to simplify the configuration of the systems involved in the Laboratory Scheduled Workflow.
The Laboratory Code Set Distribution Profile offers the means to share the same set of test/observation codes between different actors.
Other information can be also exchanged like presentation of results, laboratory codes (in which lab a test is performed), units …
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Replaces Observation/Test/Battery Code Sets
All Observation, Test and Battery code sets of the Consumer are replaced by the code sets sent by the Master. This Use Case is used both for initialization as well as periodic (weekly, monthly) update.
LCSD: Use Case 1LCSD: Use Case 1
Laboratory Code Set Consumer
Creates observation, test, battery
codes
LAB-51: Laboratory Code Set Management (REP)
Laboratory Code Set Master
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LCSD - Standard usedLCSD - Standard used
HL7 V2.5: Master Files
Messages rich enough to transport other information than just observation/test/battery codes : presentation of the results Units of measure Laboratories fulfilling this test
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Next Steps for IHE Lab in 2006Next Steps for IHE Lab in 2006
CDA rel 2 Lab ReportCDA rel 2 Lab ReportBeyond need to request/receive results, also need to share/distribute complete validated lab reports with structured tests results as one object.
Laboratory results communicated via messaging are point-to-point (request/result) and not human readable
Laboratory results can only be shared when “approved” for release by an authorized source: a document oriented laboratory report is needed.
Human readable and structured coded lab reports are necessary in a wide variety of Patient Care Coordination use cases
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As a Provider or Vendor ContributorAs a Provider or Vendor Contributor
Offer Clinical Use Case Input to Drive IHE Profile DevelopmentOffer Clinical Use Case Input to Drive IHE Profile Development
Become a member of relevant domain’s Planning or Technical Become a member of relevant domain’s Planning or Technical CommitteesCommittees
Become a member of relevant Regional/National CommitteesBecome a member of relevant Regional/National Committees
Help to shape IHE’s future directionHelp to shape IHE’s future direction
As a Vendor ParticipantAs a Vendor Participant
Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements
Attend the June Educational WorkshopAttend the June Educational Workshop
Participate in Connect-a-thons and DemonstrationsParticipate in Connect-a-thons and Demonstrations
As a Provider/Consultant ParticipantAs a Provider/Consultant Participant
Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements
Attend the June Educational Workshop Attend the June Educational Workshop
Attend Demonstrations and include IHE Integration Profiles in your RFPs Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.and Integration Projects.
How can I participate?How can I participate?
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IHE Web site:IHE Web site: www.IHE .netwww.IHE .net Frequently AskedFrequently Asked QuestionsQuestions
Integration Profiles in Technical Frameworks: Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use casesSee Volume 1 of each TF for Use cases
Cardiology IT Infrastructure Laboratory Patient Care Coordination Radiology