V3 Laboratory Domain Overview „Lab Report“ Localization in ... - HL7

V3 Laboratory Domain Overview„Lab Report“ Localization in SwitzerlandDr. Andrzej J. KnafelRoche Instrument CenterCH-6343 Rotkreuz, Switzerlandandrzej.knafel@roche.com

Current V3 Ballot Laboratory Domain ...1. In comparison with previous ballots, the scope of theLaboratory Domain for this ballot has be drasticallyreduced.2. Most of the artifacts found in this ballot are intended tosupport a single storyboard, which represents the mostcommon (or normal) flow of information involved inLaboratory communication.November 2002 A. Knafel 2

V3 Lab Refined Message Information ModelOrdersObservationsNovember 2002 A. Knafel 4

V3 Lab Order/Observation – Model SkeletonTest DefinitionTest OrdersCombination ofsingle testsTest ResultsNovember 2002 A. Knafel 5

V3 Laboratory Basics Definitions• An observation order is a request for the performance ofa test or observation.– Typically the request is made by a clinician or the laboratoryperforming, and recorded within one computer system, andthen transmitted to a second system for performance.– In some cases, the order is transmitted by other means, i.e.,information related to that order may or may not be recorded.• An observation event records the performance of a testor observation.– Typically the observation is performed by one or more personsor, perhaps, a device, recorded within one computer system,and then transmitted to a second system for storage and/or use.November 2002 A. Knafel 6

V3 Lab Application Roles1. Observation Order Global Placer Observation2. Order Global Fulfiller3. Observation Promise Global Confirmer4. Observation Promise Global Confirmation Receiver5. Observation Promise Global Informer6. Observation Promise Global Tracker7. Observation Event Global Informer8. Observation Event Global TrackerNovember 2002 A. Knafel 7

V3 Lab Trigger Events1. Observation Order Activate, Fulfillment Request2. Observation Order Activate, Rejection3. Observation Promise Activate, Confirmation4. Observation Promise Complete, Notification5. Observation Event Activate, Notification6. Observation Event Complete, NotificationNovember 2002 A. Knafel 8

V3 Lab Message and Interaction ExamplesMessage TypeObservation OrderActiveObservation PromiseCompleteObservation PromiseActiveObservation EventCompleteObservation EventActiveInteractionFulfillment Request(Lab order request)Notification(Unsolicited lab committment msg)Confirmation(Lab commitment as response to query)Notification(Unsolicited sending of ready lab results)Notification(Unsolicited info: scheduled processing)November 2002 A. Knafel 9

HL7 Switzerland – Laboratory V3 ProjectObjective:– Harmonize between HL7 and Swiss proprietary XMLproposals for„Transfer of laboratory orders, results and findings“.– „Localize“ the Laboratory Domain V3 messages inSwitzerland.November 2002 A. Knafel 10

HL7 CH – “Lab Report V3” Project Status• Current R-MIMs analyzed and localized – redefined for Swissobjectives and requirements;1. Collect detailed requirements – based on current XML proposal forproprietary Swiss standard2. Understand current R-MIM (!!! thanks to Woody Beeler)3. Find all Swiss required elements4. Remove what not needed5. Add / change what necessary ( work through HL7)6. Run it through the process & tools• “HL7 V3 Lab Report Switzerland” – proposal documentprepared and distributed in German & French for review;• XML schemes to be finalized• Work with LOINC on required codes, e.g., gestational ageNovember 2002 A. Knafel 11

HL7 CH – “Lab Report V3”• Primary characteristics for Switzerland– Focus on transfer of findings from the filler (lab) to the placer– “Loosely coupled” systems– Not all patient information details of the placer are necessary– One XML message will be send for each patient– This message contains the entire service order consisting ofmultiple positions for single service/tests (i.e., multiple ORDsin one message)– All order positions will be returned in the lab report – both,pending and ready results will be send by the lab:“pending” as intents (INT) and “ready” as events (EVN)– When multiple results exist for single test order, they arecombined through the act relationship: ComponentNovember 2002 A. Knafel 12

HL7 CH – Lab R-MIM decisions (1/2)• Elements “Removed”– ComponentA Encounterresponsibility within the placer system(see graphics)– ComponentB SubstanceAdministrationIntentcurrently not relevant – it can be added in the future– ReplacementOfresponsibility within the placer system• Elements “Ignorable”due to 0..* optionality, low load and potential for the future(sometimes we were not sure, if we will need them in the future)– DataEnterer– PerformerNovember 2002 A. Knafel 13

HL7 CH – Required R-MIM changes (1/2)• Extend EntityChoiceA in Specimen CMET for expressingownership/responsibility of the specimen.(see graphics)The ownership/responsibility shall apply to the:– Person living object, e.g., in forensic medicine for crime investigation, i.e. a hairfound on a dead body does not belonging to the dead person may belong to thesuspect. The “Specimen Owner” is the dead person, the “Patient” is the suspect.– Non person living object, e.g., animal ownership in veterinary labs.– Manufactured material – it is additionally to already defined Manufacturer(E_Organization).• O&O committee responseThe ownership/responsibility is already established by the contextof how the Specimen CMET is used. Anything beyond what isalready handled in our current ballot is outside of our scope.This means, we need to define the relation asA_ObservationAnnotation or at the „patient“and not the„specimen“ level.November 2002 A. Knafel 15

HL7 CH – Required R-MIM changes (2/2)• The act relationship Component shall have(see graphics)type_cd

Thanks for your attention ...November 2002 A. Knafel 17