Cochairs:Francois Macary Agfa HealthCare

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IHE Laboratory

• Cochairs Francois Macary - Agfa HealthCare
• Nobuyuki Chiba - AT Corporation

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Agenda

• Background (who? what? How?)
• Lab TF 2.0 Profiles available for this 2008
  connectathon
• Ongoing work for next year and later

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Background Who? What? How?
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Forces of IHE LAB

• Contributing countries
• France, Japan, Italy, NL, Germany, UK, US,
  Belgium
• Sponsors
• France GMSIH, SFIL
• Japan JAHIS, IHE-J
• US RSNA
• Technical planning committee
• Cooperative work by email, and wiki
• 2 ftf meetings / year (June, December)

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General scope of LAB TF ? 2008

• Ordering and performing clinical laboratory tests
  within acute care settings
• Tests on in vitro specimens
• Collected from human patients
• Tests performed in lab as well as on the point of
  care
• Microbiology included
• Anatomic pathology excluded (another domain in
  IHE)
• Sharing laboratory reports within a wide
  community of care providers
• Report for one patient
• Published in a document sharing infrastructure
• Electronic document (human readable importable
  in DB)

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LAB TF 2.0 Profiles for 2008 CAT
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Organization of LAB TF rel 2.0

• Volume 1 use cases, profiles, actors,
  dependencies
• Volume 2 Description of message-based
  transactions
• Volume 3 Document-based transaction (lab report)
• Volume 4 Common subset of LOINC test codes

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Lab TF Rel 2.O
HL7
Workflow Intra hospital
Laboratory Testing Workflow - LTW Laboratory
Device Automation - LDA Laboratory Point Of Care
Testing - LPOCT Laboratory Code Sets Distribution
- LCSD Laboratory Barcode Labeling - LBL
V2.5
Subset of LOINC test codes
Content Community
Sharing Laboratory Reports - XD-LAB
V3 CDA R2
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Workflow profiles dependencies
Laboratory
Care unit
Patient admin.
Security
Order mgmt
Automation
LTW
LCSD
LPOCT
LBL
LDA
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Content profile dependencies
Laboratory Or Ambulatory EHR Or Hospital EMR
Document Sharing infrastructure
Security
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Laboratory Testing Workflow (LTW) Laboratory
Device Automation (LDA)
Placer order
Order Filler
Order Placer
Filler order
Results
Work order
Results
Automation Manager
Order Result Tracker
LTW
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Units of work in LTW LDA
LDA
LTW
Order Placer
Order Filler
Automation Manager
Lab Device
Laboratory Request Order Group (ORC-4)
Placer Order (OBR-2)
Filler Order (OBR-3)
Work Order (OBR-2)
Work Order Step (OBR-2)
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Laboratory Point Of Care Testing
Scope

• 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 the ward staff
• Provides reagent supervises QC
• Clinical validation a posteriori

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Benefits 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.
• Preserving a high level of quality of the POCT
  process through its supervision by a clinical
  laboratory.

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Five major use cases

• Observations to match with an existing order,
  real-time patient identity checking
• Unordered observations, real-time patient
  identity checking
• Unordered observations on a POC device with an
  intermittent link (no patient identity check)
• Manual entry of unordered observations
• QC results

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The Actors of LPOCT

• Point 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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LPOCT Actors and Transactions
Ward
Clinical laboratory
Lab-30 (optional) Initiate testing on a specimen
Point Of Care Result Generator
Point Of Care Data Manager
Lab-31 Performed observation set (patient or QC
results)
Lab-32 Accepted observation set (patient
results)
Order Filler
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One single option Patient identity checking

• Transaction LAB-30 enables the operator to get a
  real time checking on the patient identity
• When initiating the test on the point of care
  device, the patient ID is scanned or keyed in.
  The device, then sends the patient ID, device ID,
  operator ID to the POCDM, which checks the
  patient identity and sends back the patient name,
  displayed on the device.

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Selected standard POCT1-A
Point of care device
Observation Reviewer
POCT1-A Component
Observation Recipient
Point Of Care Result Generator
Point Of Care Data Manager
IHE Actor
Order Filler
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Correspondence IHE/POCT1-A

• IHE is neutral towards the  Device Access
  Point  (DAP) interface.
• IHE is an implementation guide of
• The Device Message Layer (DML) interface, based
  on a proto-v3 HL7 XML message format
• The Observation Reporting Interface (ORI), which
  is a pure subset of HL7 v2.5 (ORU message
  structures)
• Added value The  patient identiy checking 
  option.

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Sharing Laboratory Reports XD-LAB
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Purpose

• Sharing laboratory reports
• Access to lab results in a patient-centric manner
• Retrieval of historical lab results by providers
  of care
• To improve coordination of care
• A content profile. A lab report
• Presents a set of releasable laboratory results
  to be shared as historical information.
• Is human-readable, shared between care providers
  of various specialties and the patient (e.g.
  through a PHR)
• Contains machine importable coded data (decision
  support, bio-surveillance)

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Value Proposition

• Use case 1 Hospital lab report
• Use case 2 Private lab report
• Use case 3 Lab report shared by physician
• Use case 4 Lab report automatically shared
• Use case 5 Hospitals cumulative report

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Structure of a CDA lab report
Header

• A laboratory report has its results sorted by
  specialty sections.
• Within a specialty section, the results may be
  organized by reported item sections (battery,
  specimen study, individual test).
• The relationship between reported item and
  specialty is not constrained Left up to the
  Document Source Actor.
• Each leaf section of the body is derived from a
  level 3 ltentrygt

18767-4 Blood gas
B O D Y
Arterial blood gas pO2 (mm Hg) 85
pCO2 (mm Hg) 35
Mandatory ltentrygt
18719-5 Chemistry
Electrolytes Na (mmol/l) 141
K (mmol/l) 4.4
Mandatory ltentrygt
Glucose (g/L) 0.5
Mandatory ltentrygt
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Rendering of a single specimen battery (2)
text block of the leaf section
ltrenderMultimediagt
ltentrygt ltobservationMediagt lt/observationMediagt
lt/entrygt
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A possible rendering for microbiology
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Ongoing work in LAB domain
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Preparing LAB TF 2.1 Final Text ? July 2008

• Refine microbiology messaging
• Specimen attributes (collection site, method,
  location)
• Dynamic tree of micro results (aligned with HL7
  implementation guide of Lab to EHR results
  message)
• Add the public health lab report use case to
  XD-LAB
• Extend the scope to non-human specimen related to
  a human patient
• Extend the number of CDA content modules
  (templates),
• Minor corrections and clarifications (CPs)

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Preparation of supplements

• Lab to lab workflow
• Linking images to lab results

Sub-order
Requester
Subcontractor
Results
Next face to face meeting New York, June 23-25
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• Questions?

Francois.macary_at_agfa.com