ISBT Working Party on IT Interface Task Group

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ISBT Working Party on ITInterface Task Group

• Paul Ashford

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Interface Task Force

• Review current status of interfacing in
  transfusion practice
• Understand problems and weaknesses
• Review existing standards and their suitability
• Develop guidelines/standards to improve practice

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Previous work of WPADP

• Interface protocol was worked on during 1990s
• Draft document prepared Standard Specification
  for Transferring Information between Blood Bank
  Equipment and Information Management Systems
• Advanced draft prepared in 1998, circulated for
  comment
• Did not proceed to publication

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Previous work of WPADP

• Protocol was based on existing ASTM Standards, in
  particular ASTM E-1394
• Some vendors based their interfaces on this
  protocol

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Current Status of Interfacing
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Current Status of Interfacing
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Current Status of Interfacing

• Wide variety of information formats
• Limited use of standards
• Plethora of interface solutions
• Specific problems for transfusion systems
• GMP systems, validation impact, 510k

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Existing Standards

• ASTM E-1394 most widely used interface standard
• Published 1991, updated 1997
• Standard withdrawn by ASTM in 2002
• Re-issued as LIS2-A in 2003 by NCCLS
• Now maintained as LIS2-A2 by CLSI
• AUTO3-A issued in 2000 by CLSI
• Based on HL7 v2.x messaging
• New draft AUTO3-A2

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Oslo Workshop

• IF Task group workshop meeting held in July 2008
• Recommends use of LIS2-A2 and AUTO3-A/HL7 for
  interfaces to transfusion systems
• LIS2-A2 protects current investment in many
  interfaces
• AUTO3-A/HL7 supports future standardization on
  HL7 (v2.x) messaging formats
• HL7 v3 ????

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First Step

• Recommend that equipment should output
  information in LIS2-A2 and/or AUTO3-A/HL7
  compliant format, using the appropriate subset of
  records
• In LIS2-A2, the H, P, O, R and L records.
• In AUTO3-A/HL7 the MSH, PID, OBR and OBX records

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Is this enough?

• LIS2-A2 and AUTO3-A/HL7 standards provide a well
  defined message structure
• Do not tightly define the data elements placed in
  the structure
• Individual suppliers can name results
  differently, format data differently, and provide
  different subsets of data
• Not standard enough for our needs

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Samples

• LIS2-A2
• R2Weight of donation452gFRSK20080708
  11190220080708112600None
• Weight of donation452g
• HL7 v2.x
• OBX2NMDonation weight0.515kgF200807
  08112600RSK
• Donation weight0.515kg

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What else can be done?

• Both LIS2-A2 and HL7 support universal test and
  observation identifiers
• Universal identifiers refer to a reference
  organization which can apply additional
  attributes to the observation
• A range of universal identifiers, IBTxxx are
  reserved for blood transfusion usage
• LOINC and SNOMED are examples of sources of
  universal identifiers
• LOINC Logical Observation Identifiers Names and
  Codes
• SNOMED Systemized Nomenclature of Medicine

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Example

• OBX1CWE883-9ABO GroupLN1F-D1250Type
  OSNM33.4NF
• 883-9ABO GroupLN1F-D1250Type OSNM33.4

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Will existing systems meet our needs?

• LOINC potentially suitable but existing codes
  do not meet transfusion instrument interface
  needs
• Not widely used outside USA
• Focus is on final reporting rather than
  intermediate results

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Universal identifiers for transfusion
instrumentation

• Utilize a member of the IBTxxx range as a
  universal reference
• Define reference tables of test results and
  observation values
• Allow rigorous definition of entries
• Standardizes critical data fields
• Allows vendors freedom to add additional data

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Example
Test Identifier Table
Observation Identifier Table
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Example

• OBR1J000108123456052346Weight
  MixerIBT00220080708112600
• OBX1NM1235Draw durationIBT002418sF
  20080708112600RSK
• OBX2NM1236Weight of donationIBT002479g
  F20080708112600RSK
• OBX3NM1237Volume of donationIBT002456ml
  F20080708112600RSK
• OBX4TX1238Collection bag typeIBT0021BA12345
  67F20080708112600RSK
• OBX5NM1239Collection bag lotIBT002012345678
  9F20080708112600 RSK

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Example

• OBR1J000108123456052346Weigh
  MixIBT00220080708112600
• OBX1NM1235Draw durationIBT002418sF
  20080708112600RSK
• OBX2NM1236Weight of donationIBT002479g
  F20080708112600RSK
• OBX3NM1237Volume of donationIBT002456ml
  F20080708112600RSK
• OBX4TX1238Collection bag typeIBT0021BA12345
  67F20080708112600RSK
• OBX5NM1239Collection bag lotIBT002012345678
  9F20080708112600 RSK
• 2346Weigh MixIBT002

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Example

• OBR1J000108123456052346Weight
  MixerIBT00220080708112600
• OBX1NM1235Draw durationIBT002418sF
  20080708112600RSK
• OBX2NM1236Weight of donationIBT002479g
  F20080708112600RSK
• OBX3NM1237Volume of donationIBT002456ml
  F20080708112600RSK
• OBX4TX1238Collection bag typeIBT0021BA12345
  67F20080708112600RSK
• OBX5NM1239Collection bag lotIBT002012345678
  9F20080708112600 RSK
• 1235Draw durationIBT002418s

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Future Plans

• Develop pilot set of messages
• Publicize activities
• Encourage wider stakeholder participation on Task
  Force

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Contacts

• Task Force Chairman Pia Bruce, Finland
• Pia.Bruce_at_veripalvelu.fi