Laboratory IT Initiatives in Saskatchewan HL7 Regina Conference June 7, 2001

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Laboratory IT Initiatives in SaskatchewanHL7
Regina Conference - June 7, 2001

• Presentation Purpose is to discuss use of HL7 V3,
  not the Lab Standard itself
• Vision for Electronic Test Requisition and Result
  Reporting
• Provincial, not in-hospital/lab
• presentation emphasis on CONTENT, not FORMAT
• CONTENT
• HL7 V3 Reference Information Model
• Use of Registries for content quality control
• Strategy Schedule
• Leverage from British Columbias work on LOINC
  HL7
• Saskatchewan is reviewing the BC Standard and
  identifying areas of difference for resolution
• Areas of difference include use of registries and
  associated governance models (e.g. assignment of
  new LOINC codes)
• Partnership through the Western Health
  Information Collaborative (WHIC) CIHI

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Laboratory IT Initiatives in SaskatchewanVISION
Registries to Support Identifiers for Clients,
Providers, Lab Facilities/Organizations and Lab
Test Identifiers Nomenclatures
Provincial Laboratory - Reference Public Health
Lab Feeder Systems
Tele-Homecare
Provincial Laboratory

Telemedicine
Laboratory Specific Data Messaging Standards
Health region
Regional Clinical Data Repository
Community Pharmacy Feeder Systems
Lab Feeder Systems
Pharmacy
Laboratory
Physician Clinic Feeder Systems
ER
MPI/ADT
Interfaces
Clinic Management
OC
Radiology
Lab
Pharmacy
Speech Path
LTC
Env Health
Hospital Feeder Systems
LTC Facility Feeder Systems
Home Care
Immunization
Community Clinic Feeder Systems
Health region
Tele-Homecare
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HL7 RIM Core Classes
Employee-employer Patient-provider Practitioner-pr
ovider Practitioner-certifier
Entity
Participation
Act
Role
Test Compendium Result Nomenclature Registries
Referral Transportation Supply Procedure Condition
Node Consent Observation Medication Act
complex Financial act
Guarantor Healthcare provider Insurer Military
person Notary public
Organization Living Subject Material Place Health
Chart
Provider Registry (WHIC)
Service Recipient Registry (CIHI)
Laboratory Registry Management System
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Laboratory IT Initiatives in SaskatchewanUse of
REGISTRIES for Data Content
Overall Business Process Model Registry
Management Infrastructure

• (Laboratory) Facility Registry
• contains contact data for all Medical
  Laboratories in Saskatchewan
• Planning for development internal to
  Saskatchewan? or WHIC?
• a web-based Registry Management System associated
  with Laboratory Licensing
• will require an owner, likely Lab
  Licensing/Quality Assurance

• Service Recipient Registry
• contains index of all identifiers used by all
  Sask stakeholders for all patients
• Planning for development being led by CIHI and
  involves provinces, territories and Health Canada
  jurisdictions
• will require HL7 messages to be balloted
• will require an owner not yet identified

• Test Compendium Registry contains data for all
  Medical Tests done by all Labs in Saskatchewan
• contains an index for all nomenclatures used by
  all Labs in Sask for Orders and Tests as well as
  LOINC codes for these tests
• a web-based Registry Management System associated
  with Laboratory Licensing - a possible WHIC
  collaboration?
• will require an owner, likely Lab
  Licensing/Quality Assurance

• Service Provider Registry
• contains index of all identifiers used by all
  Sask stakeholders for all Providers (individuals)
• Planning for development being led by WHIC
• will require HL7 messages to be balloted
• will require an owner not yet identified

Strong Link
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Laboratory IT Initiatives in SaskatchewanTACTICAL
PLANS STATUS
Project Deliverables - Design Phase Overall
Business Data Model Registry Management
Infrastructure
Service Recipient Registry There a 19 publicly
funded jurisdictions that issue health cards with
unique identifiers in Canada. There are an
unknown number of internal (shadow) identifiers
assigned by health delivery organizations, and an
unknown number of identifiers issued by private
3rd party payors. One person may have several
current identifiers presented during one or more
care episodes.

• Stakeholder Organization
• (e.g. Health Registration, SDH,....)
• Sask Unique Id
• Organization Name
• Contact Data

• Recipient Person/Organization Xref
• WHIC Unique (Person) Id
• WHIC Unique (Organization) Id
• Person/Organization Id

• Recipient Person
• WHIC(?) Unique Id
• Person Name
• Person Data

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Laboratory IT Initiatives in SaskatchewanTACTICAL
PLANS STATUS
Project Deliverables - Design Phase Overall
Data Model Registry Management Infrastructure
Service Provider Registry Coming in the fall of
2002.

• Stakeholder Organization
• (e.g. ProvLab, SDH, Regenstrief, SNOMED....)
• Sask Unique Id
• Organization Name
• Contact Data

• Provider Roles
• (e.g. Physician, Pharmacist, Nurse, Dentist, Lab
  Tech....)
• WHIC Unique Id
• Role Name
• Role Data

• Provider/Role/Organization Xref
• WHIC Unique (Person) Id
• WHIC Unique (Role) Id
• Sask Unique (Orgaization) Id
• (local) Provider Id
• (local) Provider Data

• Provider Person
• WHIC Unique Id
• Person Name
• Person Data

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Laboratory IT Initiatives in SaskatchewanTACTICAL
PLANS STATUS
Project Deliverables - Design Phase Overall
Data Model Registry Management Infrastructure
(Laboratory) Facility Registry

• Stakeholder Organization
• (e.g. ProvLab, SDH, RHD, PAHD,....)
• Sask Unique Id
• Organization Name
• Contact Data

• Laboratory Facility QA/Licensing Events
• Sask Unique Id
• Event Id
• Event Data

• Laboratory Facility
• (e.g. ProvLab, SDH Laboratory....)
• Sask Unique (Organization) Id
• Sask Unique Facility Id
• Facility Name
• Contact Data

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Laboratory IT Initiatives in SaskatchewanRegistry
Design
Project Deliverables - Design Phase Overall
Data Model Registry Management Infrastructure
About 200 Labs in Saskatchewan are publicly owned
and regulated by the Saskatchewan College of
Physicians Surgeons and are licensed by
Saskatchewan Health. There are almost 230
Physician Office Labs in Saskatchewan.
Saskatchewan needs to build a Registry Management
System according to the guidelines of the HL7V3
RIM. This may be a feeder system to the WHIC
Provider (Organization) Registry. It must,
however, be closely tied to the Test Compendium
Registry for licensing and information management
purposes.
(Laboratory) Facility Registry

• Stakeholder Organization
• (e.g. ProvLab, SDH, RHD, PAHD,....)
• Sask Unique Id
• Organization Name
• Contact Data

• Laboratory Facility QA/Licensing Events
• Sask Unique Id
• Event Id
• Event Data

• Laboratory Facility
• (e.g. ProvLab, SDH Laboratory....)
• Sask Unique (Organization) Id
• Sask Unique Facility Id
• Facility Name
• Contact Data

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Laboratory IT Initiatives in SaskatchewanTACTICAL
PLANS STATUS
Project Deliverables - Design Phase Overall
Data Model Registry Management Infrastructure
Test Result Nomenclature Registry
Test Compendium Registry

• Saskatchewan Lab Nomenclatures
• Sask Unique Id
• Organism, Outcome Name

• Stakeholder Organization
• (e.g. ProvLab, SDH, Regenstrief, SNOMED....)
• Sask Unique Id
• Organization Name
• Contact Data

• Provincial Test
• Sask Unique Id
• Order Name
• Business Rules

• Test Xref by Organization
• Sask Unique (Test) Id
• Sask Unique (Org) Id
• Test Name
• Test Code
• Business Rules

• Nomenclature Xref by Organization
• Sask Unique (Nom) Id
• Sask Unique (Organization) Id
• Name

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Laboratory IT Initiatives in Saskatchewan
Registry Design
Project Deliverables - Design Phase Overall
Data Model Registry Management Infrastructure
Several grouping levels of this data are
required 1. Laboratory Licence Test Group 2. A
Test Panel/Battery (for both Orders
Instruments) 3. A Named Test 4. A specific
Test/Result (LOINC) HL7 refers to Act
Relationship A relationship between two acts.
This includes numerous relationships, such as
part-of relationships, which allow both
temporal and non-temporal groupings of instances
of acts. Examples include batteries of tests or
longitudinal guidelines
Test Compendium Registry

• Provincial Test
• Sask Unique Id
• Order Name
• Business Rules

• Stakeholder Organization
• (e.g. ProvLab, SDH, Regenstrief, SNOMED....)
• Sask Unique Id
• Organization Name
• Contact Data

• Test Xref by Organization
• Sask Unique (Test) Id
• Sask Unique (Org) Id
• Test Name
• Test Code
• Business Rules

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Laboratory IT Initiatives in Saskatchewan
Registry Design
Project Deliverables - Design Phase Overall
Data Model Registry Management Infrastructure
Test Result Nomenclature Registry
These Nomenclatures are also being addressed for
Public Health Surveillance. The proposed data
structure would allow any required
cross-reference between local, provincial and
national identifiers.

• Stakeholder Organization
• (e.g. ProvLab, SDH, Regenstrief, SNOMED....)
• Sask Unique Id
• Organization Name
• Contact Data

• Saskatchewan Lab Nomenclatures
• Sask Unique Id
• Organism, Outcome Name

• Nomenclature Xref by Organization
• Sask Unique (Nom) Id
• Sask Unique (Organization) Id
• Name

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Laboratory IT Initiatives in SaskatchewanAction
Plan Schedule for Registry Development
Implementation
Provider Registry (WHIC)
Service Recipient Registry (CIHI)
Laboratory Registry Management System
Lab Data Standards Business Design
Populate the Lab/Test Compendium Result
Registries
Test Compendium Result Nomenclature Registries
WHIC Collaboration?
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Laboratory IT Initiatives in Saskatchewan Use of
REGISTRIES for Data Content
Project Deliverables - Design Phase Overall
Business Process Model Ordering and Result
Reporting
Enter Order /Retrieve Results (Physician, Lab)
Prepare Mail Specimen (Lab, Clinic)
Lab Web Portal
Lab Web Portal
Lab Web Portal
Receive Sample /Retrieve Order /Do Test /Record
Results (Laboratory)
Other JurisdictionRegistries
HL7
Saskatchewan Registries
Enter Order /Retrieve Results (Physician, Lab)
HL7
Prepare Mail Specimen (Lab, Clinic)
HL7
HL7
HL7
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Laboratory IT Initiatives in SaskatchewanScenario
s of Possible Laboratory Transactions manual
systems using Web portal
Dr. Smith orders CBC on John Doe via Web portal
info verified by Web application using
registries. John Doe goes to LittleTown Lab
at Lab reception, info retrieved by Web
application and collection recorded - sample
numbered. Sample taken to LittleTown Lab bench
info retrieved by Web application, sample
processed and result recorded by Web application.
Added info verified using registries.
Dr. Smith looks for John Doe result on Web and
finds it. Dr. Smith sends John Doe to Dr.
Jones, a specialist. Dr. Jones looks on the Web
portal for past lab test results for John Doe and
finds the CDC result.
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Laboratory IT Initiatives in SaskatchewanScenario
s of Possible Laboratory Transactions computer
systems using messaging
Dr. Brown orders cholesterol on Mary Doe from his
practice management system info verified by
messaging to registries. Mary Doe goes to
Somewhere Bleeding Station info retrieved and
collection recorded by messaging - sample
numbered. Sample arrives at BigLab info
retrieved by LIS application through messaging,
sample processed and result sent through
messaging. Added info verified using registries.
Dr. Brown looks for Mary Doe result on his PMS
and finds it along with a cholesterol
fractionation done because cholesterol was high.
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Laboratory IT Initiatives in SaskatchewanScenario
s of Possible Laboratory Transactions - mixed
Doctor uses the Web, but the Collection Point/Lab
uses a computer system with messaging. Lab
test was done rurally using Web applications but
is being found by another physician because the
patient became sick when visiting town. The city
physician has a practice management system.
Assumes the order and results exist in a central
database or directory share by Web apps and HL7
messaging.
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Laboratory IT Initiatives in SaskatchewanScenario
s of Possible Laboratory Transactions
validation early
Dr. White attempts to place an order and finds
that the patient does not exist in the registry
with the ID given to the doctor. He finds a
Richard Robin, address in townA, in the
registry, while he knows his patient as Dick
Robin, address in townB. The patient confirms
that he is the same person. Doctor changes his
system to Richard and the registry to the
address in townB. When patient arrives to have
sample collected there is no problem with name or
birth date.
Lab calls organism E.coli. System consults
registry for agreed name Escherichia coli.
Referral lab goes to registry to retrieve its
name E COLI before further lab work on the
organism.
Assumes that all messages are validated before
sending using the registries.
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Laboratory IT Initiatives in SaskatchewanScenario
s of Possible Laboratory Transactions - help
Dr. Farout wants to order a very unusual test.
His system does not list it, but he finds and
orders it via the Web site rather than his
PMS. The patient goes to a collection center and
they do not have the test on their system either.
They use the Web site to find what has to be
collected and where it must be sent. The lab
does not do this test without prior agreement
with the physician on the merit of the
circumstances. They decide to substitute another
test and do the ordered test only if the
substitute has an abnormal result. The lab
cancels the ordered test and result (as normal)
the substitute test with a comment. The
physician uses the comment info to access a paper
on this group of tests and their interpretation
on the Web portal.
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Laboratory IT Initiatives in SaskatchewanScenario
s of Possible Laboratory Transactions
Completely Local
An intern orders a test on a patient in hospital
directly into the hospitals LIS. Collection and
reporting are also entirely within the LIS. The
whole transaction can be reported to a central
directory or database with a series of HL7
messages after the fact. The LIS will have to
have the standards to make valid messages after
the fact. Alternatively, the hospital may use
messaging to communicate between separate ward,
collection and lab systems. A lab might even have
a number of separate specialized lab systems
rather than a single LIS and use messaging for
input and output.
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Laboratory IT Initiatives in SaskatchewanScenario
s of Possible Laboratory Transactions
Incomplete testing
Dr. Black instructs a patient to go to a local
hospital for a lab test and orders the test on
the Web. The patient decides he feels better and
will not go for the test. At some point, the
central system can notify Dr. Black that his
patient did not have the test done and cancel the
order. Or
Before this, the patient may feel bad again and
go to Dr. Green. The physician orders the same
test and gets a message that there is an order
with collection pending. There are many ways to
resolve this situation depending on the
physicians.
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Laboratory IT Initiatives in SaskatchewanAction
Plan Schedule for Laboratory Message and Data
Standard Development Implementation
WHIC
CIHI
CIHI Lab Data Standards HL7 Message Specification
WHIC Lab Data Standards HL7 Message Specification
Lab Data Standards HL7 Message Balloting
Lab Data Standards Business Design
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Laboratory IT Initiatives in Saskatchewan3rd
Party Laboratory, Hospital Practice Management
System Impacts
HL7 Compliance with Laboratory Test Order
Results Associated Messages Service Recipient
Look-up, Add Change Messages Service Provider
Look-up, Add Change Messages Test Compendium
Look-up Messages, (Add Change?) Result
Nomenclature Look-up Messages, (Add
Change?) Network Security Compliance
CIHI Lab Data Standards HL7 Message Specification
WHIC Lab Data Standards HL7 Message Specification
Lab Data Standards HL7 Message Balloting
Lab Data Standards Business Design