What IHE Delivers 1 IHE Netherlands Lab Working Group Update Alexander Henket May 15, 2009 - Kyoto.
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Transcript of What IHE Delivers 1 IHE Netherlands Lab Working Group Update Alexander Henket May 15, 2009 - Kyoto.
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
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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…..
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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