What IHE Delivers1

IHE NetherlandsIHE NetherlandsLab Working GroupLab Working Group

UpdateUpdate

Alexander HenketAlexander Henket

May 15, 2009 - KyotoMay 15, 2009 - Kyoto

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BackgroundBackground

IHE-Lab start December 2007IHE-Lab start December 2007

““Joint” initiative between IHE Netherlands Joint” initiative between IHE Netherlands and NICTIZand NICTIZ

GoalGoal Define use-cases for national exchange of lab-Define use-cases for national exchange of lab-

informationinformation Define interoperability specification taking Dutch Define interoperability specification taking Dutch

Healthcare Infrastructure into accountHealthcare Infrastructure into account

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MethodologyMethodology

Phase I (done)Phase I (done) ““User driven”User driven” Defining “use-cases”Defining “use-cases”

Phase 2 (in progress)Phase 2 (in progress) ““Defining technical details”Defining technical details”

• Data format and transport protocolData format and transport protocol

Phase 3Phase 3 Proof-of-conceptProof-of-concept

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Phase 1: Selecting Use-casesPhase 1: Selecting Use-cases

Lab-to-Lab Communication

Internal Results Management

External Results Management

External Order Management

Internal Order Management

LAB

LAB(external)

Primary care

Out-patient Clinic

Hospital/Clinic

Prik-poli(internal)

Prik-poli(external)

EPR/HIS(internal)

Primary care

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Fase 2 (In Progress)Fase 2 (In Progress)

Technical deep-dive on use-cases

Define and review (technical) interactions between actors including the Dutch Healthcare infrastructure (AORTA)

Investigate use of HL7 v3 CDA

Define a CDA template for a lab-order.

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Technical deep-diveTechnical deep-dive

HA3HA2

Laboratorium2

HA1

Index

Scenario HA, prikpost, lab

externprikpunt

Laboratorium1

internprikpunt

GPGP

LabLab

ExternalExternal

Phlebotomy stationPhlebotomy station

InternalInternal

Phlebotomy stationPhlebotomy station

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Technical Deep-diveTechnical Deep-dive

GP System

Referral Requestor

Hospital

Order Placer

Lab

Order Filler

Referral Dispatcher LAB-1 LAB-2

Referral Request(ITI TF-2: 3.Z)

Analogy with Document based Referral Request ProfileAnalogy with Document based Referral Request Profile

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Interaction Dutch AORTAInteraction Dutch AORTA

ReferralIndex

Transaction 2

GP System

Content Creator

Referral Requestor

Hospital

Order Placer

Lab

Order Filler

Referral Dispatcher LAB-1 LAB-2

Phlebotomy lab

Content Reader Content Updater

Transaction 3

Referral RepositoryTransaction 1

Tra

nsac

tion

1

Transaction 3

Tra

nsac

tion

4

Transaction 4

Tra

nsac

tion

4

AORTAAORTA

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Interaction Dutch AORTA (2)Interaction Dutch AORTA (2)Prikpost

Huisarts

Content Reader Content Updater

Repository

Repository

Lab

Content Reader

Transaction 3

Tra

nsac

tion

4

Transaction 4Verwijsindex

Transaction 5

Transa

ction 2

Transaction 3

Transacti

on 1

Transaction 2

Content creator

Trans

actio

n 1

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Use of HL7v3 CDAUse of HL7v3 CDA

Main debateMain debate Should the “lab referral” be a document or a Should the “lab referral” be a document or a

message?message? Focus on key set of select criteria (persistence, Focus on key set of select criteria (persistence,

ownership, signature, readability, etc.)ownership, signature, readability, etc.)

ConclusionConclusion Order should be an electronic documentOrder should be an electronic document Main criteria: persistence, readabilityMain criteria: persistence, readability Lab results should also be an electronic document Lab results should also be an electronic document

to stay consistent (less clear for Clin. Chemistry)to stay consistent (less clear for Clin. Chemistry)

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Defining CDA TemplateDefining CDA Template

Available standardsAvailable standards NTA 7508 (Dutch NEN standard defining an NTA 7508 (Dutch NEN standard defining an

edifact lab order and result set) edifact lab order and result set) IHE-Lab, vol 3IHE-Lab, vol 3 HL7 v3 Lab ModelHL7 v3 Lab Model

To be continued…..To be continued…..

12WWW.IHE-NL.ORG

Use CasesUse Cases

standard community orderstandard community order

order discontinued by laboratoryorder discontinued by laboratory

order canceled by specimen collection order canceled by specimen collection centercenter

order modified by order placerorder modified by order placer

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ActorsActors

Order Tracer will also send out Order Tracer will also send out notifications to the Order Placer upon notifications to the Order Placer upon discontinuation or cancellation: is that discontinuation or cancellation: is that extending the actor?extending the actor?

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TransactionsTransactions

Specimen reports will have an append Specimen reports will have an append relationship to the order.relationship to the order.

How do we handle Result/Order relationship How do we handle Result/Order relationship when we cannot link at document level? when we cannot link at document level? inFulFillmentOf will link to the order, but the inFulFillmentOf will link to the order, but the order it references cannot be the CDA order it references cannot be the CDA document that contained the order. Instead document that contained the order. Instead it will reference into the CDA Body of it will reference into the CDA Body of another document. Preadopt CDA Release 3another document. Preadopt CDA Release 3

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Transactions cont’d: statusTransactions cont’d: status

Use RCMR messages only, or is Shared Use RCMR messages only, or is Shared Messages/ActStatus topic viable? Document Messages/ActStatus topic viable? Document Status changes in RCMR go to Document Status changes in RCMR go to Document Recipient which does not fit requirementsRecipient which does not fit requirements

Should there be more statuses than: ordered, Should there be more statuses than: ordered, accepted, in progress, completed, e.g. accepted, in progress, completed, e.g. specimen received?specimen received?

Can another party than the author /custodian of Can another party than the author /custodian of a document change the status of a document?a document change the status of a document?

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CONTENTSCONTENTS

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