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The Future of Laboratory Implementation Guides
Hans Buitendijk,M.Sc, FHL7, Senior Strategist Cerner HL7 Board Member, Chair Policy Advisory Committee, Co-Chair HL7
Orders/Observations Work Group, Co-Chair Clinical Statement Work Group, FHIR Management Group
Ken McCaslin, MAR, FHL7, Senior Manager Health Products, Accenture
HL7 Board Member, HL7 Technical Steering Committee (TSC) Chair, Co-Chair HL7 Orders/Observations Work Group
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
Agenda
High-level overview Message profiles Conformance driven at message level, segment to
segment, within field, across fields and functional behavior at the edges
Harmonized across all laboratory Implementation Guides (IG) providing full, closed-loop interoperability
Public Health Reporting integrated with Laboratory Results IG through the use of message profile
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
Purpose driven IGs, Ambulatory Focused: – Test Compendium Message -> Electronic Directory of Services IG (eDOS
IG) – Lab Order Message -> Laboratory Order Interface IG (LOI IG) – Lab Result Message -> Laboratory Result Interface IG (LRI IG)
Conformance defined at message, segment and field levels – Ability to extract conformance statements into validation requirements
to evaluate senders and receivers of messages Datatype flavors to help refine requirements based on the field the
datatype is used Message profiles that drive variances in conformance and constraints Common Value Set definition Consistent behavior across all IGs by message, segment and field
requirements
High Level Overview
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
Purpose driven Implementation Guides (IG) eDOS IG
Provides the Lab Test
Compendium to the
EHR
Lab EHR
LOI IG Standardize
lab order message
LRI IG Standardize lab Result message
The end points are the functional systems, but the vendors can be vastly unique therefore the IG is not driven by unique end point system/design characteristics but by function. Therefore the vendors do not drive the IG, the community does with the vendors demonstrate their ability to comply based on meeting the conformance criteria.
Value Sets
Functional Edge Behavior
Functional Edge Behavior
Func
tiona
l Ed
ge B
ehav
ior
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
The relationship between IGs
eDOS IG Provides the
Lab Test Compendium
to the EHR
LOI IG Standardize
lab order message
LRI IG Standardize lab Result message
Order code, specimen and test requirements in the eDOS IG drive the content in the LOI IG
indicating what must be contained in the order message. Examples: data that must be
collected: specimen quantity, time that specimen was collected 12 or 24 hours
LOI IG Standardize
lab order message
The Order Message drives the relationship of the patient in both systems. The consistent
format drive better delivery of lab results into the EHR.
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
Message Profiles: Lab Orders
Message profiles provide consistent
methods to constrain components across
Implementation Guides (IG)
IG specific profiles help refine specific
issues and requirements
Each profile builds on the constraints created by the previous profile to create a consistent Incremental requirement of the IG.
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
The Implementation Guide Tree
Implementation Guide 1
Base Standard Implementation Guide
Implementation Guides and Profiles attempt to reduce if not eliminate ambiguity for defined use cases
Implementation Guide 2 Implementation Guide 3
Message Profile: Non-globally unique IDs
Message Profile: Public Health
Message Profile: New Born time stamp
Message Profile: Unique Order Number
Profiles that are used in the message are identified in the MSH-21 and can be
added or taken away based on the requirement. E.g.,
New Born Time stamp below would be only for
infant reporting
Message Profile: Common
Message Profile: Globally unique IDs
Message Profile: Unique Order Number
Message Profile: Non-globally unique IDs
Message Profile: New Born time stamp
Message Profile: Unique Order Number
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
Driving conformance from profile to component
This message structure conformance statement indicates: Financial Information Profile Usage: C(R/O) Condition Predicate: PV1-20 (Financial Class) is valued T (Third Party) Effectively meaning the Insurance message structure is not necessary unless the billing is to a third party insurance payor.
Field level conformance requirements refine field requirements based on unique data type flavors, in this case driving date/time stamp requirements
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
LOI IG Standardize lab order
message
LOI IG Standardize lab order message
LOI IG Standardize
lab order message
LRI IG foundation for Public Health Reporting
The LRI IG provides basic, ambulatory lab result reporting capabilities. The message establishes the constraints that help partners define the requirements that they must adhere to to achieve near out-of-the box lab results interoperability. Examples include: • Minimum data set necessary to communicate a meaningful lab result • Use of OIDs to create unique identifiers rather than locally defined
identifiers. • Requirement to send/receive minimum data set without requiring any
further data (unless mutually agreed to)
LRI IG Standardize lab Result message
LOI IG Standardize lab order
message
LOI IG Standardize lab order message
LOI IG Standardize
lab order message
LRI IG Standardize lab Result message
Changing the assembled profiles changes the LRI IG requirements. The Electronic Laboratory Reporting to Public Health Release 2 (ELR IG) uses the base LRI IG and a specific assembly of message profiles to provide a lab results message that meets the Public Health Reporting requirements as designated by the CDC. This flexibility provides for one IG to meet many different requirements while maintaining consistency across the lab results reporting domain.
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
Data Type Flavors – Timestamp (TS) Example
The TS data type has flavors from TS_0 to TS_6 and based on the field, the flavor drives component requirement
New Born screening is an example where time stamps on results at times need to be specific down to the hours, in other cases specific down to the day and therefore the time stamp requirements would be drive first at a profile level, New Born profile that lists the fields that need to be specific down to hours and minutes. Examples are Date of Birth and time specimen was collected.
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.
Next Steps
Wide adoption Functional Edge Behavior for all guides Integrated test suite (NIST) Acute Care, Clinical Genomics, Anatomic
Pathology Drive towards Normative