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Cross-Paradigm Behavioral Health Exchange Project

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Cross-Paradigm Behavioral Health (BH) Data Exchange Project

Drug Toxicology Scenario

The following is an example scenario intended to illustrate how implementers will use HL7 V2.5.1 for lab orders and result reporting, C-CDA documents, and FHIR resource to convey drug toxicology information for a patient receiving treatment for PTSD (ICD-10 F43.10).

  • 24349-3 Drugs of abuse 5 panel - Urine
    • 8150-5: Amphetamines [Mass/volume] in Urine (ug/L)
    • 3394-4: Benzoylecgonine [Mass/volume] in Urine (mg/L)
    • 42860-7: Cannabinoids [Mass/volume] in Urine (ug/L)
    • 8220-6: Opiates [Mass/volume] in Urine (ng/L)
    • 3937-0: Phencyclidine [Mass/volume] in Urine (ug/L)


Drug Toxicology Ordering

A BH EHR sends a Drug Toxicology Order (as an LOI-conformant V2.5.1 message):

  • The patient, Sally Share, is treated for PTSD and her provider suspects that she may be suffering a substance use disorder
  • The provider order a toxicology panel (24349-3^Drugs of abuse 5 panel - Urine) for Sally Share from a local laboratory
  • The provider collects the specimen (urine) and sends to the laboratory - a reference to the specimen is included in the order

MSH|^~\&|BH-EHR^2.16.840.1.113883.3.72.5.22^ISO|EHR Facility^2.16.840.1.113883.3.72.5.23^ISO|Reference Laboratory^2.16.840.1.113883.3.72.5.20^ISO|Lab Facility^2.16.840.1.113883.3.72.5.21^ISO|20160211184101-0500||OML^O21^OML_O21|NIST-LOI_8.0_1.1-GU|T|2.5.1|||AL|NE|||||LOI_Common_Component^LOI Base Profile^2.16.840.1.113883.9.66^ISO~LOI_GU_Component^LOI GU Profile^2.16.840.1.113883.9.78^ISO~LAB_PRU_Component^LOI PRU Profile^2.16.840.1.113883.9.82^ISO

PID|1||PATID1234^^^&2.16.840.1.113883.3.72.5.30.2&ISO^MR||Share^Sally^A^^^^L||19281011|F||2106-3^White^HL70005|1500 Patient Way^Apt 4^Huntington Park^CA^90255^^H|||||||||||H^Hispanic^HL70189

ORC|NW|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||ORD798642^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO|||||20160124||57422^Hippocrates^Harold|57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^^PH^^^626^9876543^1||||||2^Patient has been informed of responsibility, and agrees to pay for service^HL70339

OBR|1|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||24349-3^Drugs of abuse 5 panel - Urine^LN|||201603190830-0800|||||||||57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^^PH^^^626^9876543^1

DG1|1||F43.10^Posttraumatic Stress Disorder^I10C|||F|||||||||3

SPM|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||122575003^UrineSpecimen^SCT|||||||||||||201603190830-0800


Drug Toxicology Results Reporting

The laboratory receives the specimen from the BH provider and performs the tests specified in the panel definition (http://s.details.loinc.org/LOINC/24349-3.html?sections=Simple). The lab transmits the Lab Results message (LRI conformance V2.5.1 message) to the BH EHR to be reviewed and interpreted by the provider. The example results transactions are using 42860-7^Cannabinoids [Mass/​volume] in Urine rather than 52954-5^Cannabinoids [Moles/volume] in Urine to analyze the level of Cannabinoids in urine.

MSH|^~\&|Reference Laboratory^2.16.840.1.113883.3.72.5.20^ISO|Lab Facility^2.16.840.1.113883.3.72.5.21^ISO|BH-EHR^2.16.840.1.113883.3.72.5.22^ISO|EHR Facility^2.16.840.1.113883.3.72.5.23^ISO|20160601140551-0500||ORU^R01^ORU_R01|NIST-LRI-GU-002.00|T|2.5.1|||AL|NE|||||LRI_Common_Component^^2.16.840.1.113883.9.16^ISO~LRI_GU_Component^^2.16.840.1.113883.9.12^ISO~LRI_RU_Component^^2.16.840.1.113883.9.14^ISO

PID|1||PATID1234^^^&2.16.840.1.113883.3.72.5.30.2&ISO^MR||Share^Sally^A^^^^L||19281011|F||2106-3^White^HL70005|1500 Patient Way^Apt 4^Huntington Park^CA^90255^^H|||||||||||H^Hispanic^HL70189

ORC|RE|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||ORD798642^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO|||||20160124||57422^Hippocrates^Harold|57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^^PH^^^626^9876543^1||||||2^Patient has been informed of responsibility, and agrees to pay for service^HL70339

OBR|1|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||24349-3^Drugs of abuse 5 panel - Urine^LN|||201603190830-0800|||||||||57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^^PH^^^626^9876543^1

OBX|1|NM|8150-5^Amphetamines [Mass/volume] in Urine^LN||23|ug/L^micrograms per liter^UCUM|0 to 10|H|||F|||20160103143428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|2|NM|3394-4^Benzoylecgonine [Mass/​volume] in Urine^LN||0.3|mg/L^milligrams per liter^UCUM|0 to 0.1|H|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|3|NM|42860-7^Cannabinoids [Mass/​volume] in Urine^LN||15|ug/L^micrograms per liter^UCUM|0 to 10|H|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|4|NM|8220-6^Opiates [Mass/​volume] in Urine^LN||0|ng/L^nanograms per liter^UCUM|0 to 10|N|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|5|NM|3937-0^Phencyclidine [Mass/​volume] in Urine^LN||23|ug/L^micrograms per liter^UCUM|0 to 10|H|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

SPM|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||122575003^Urine Specimen^SCT|||||||||||||201603190830-0800

Send Drug Toxicology Results in a Referral Document to Substance Abuse Treatment Provider

The mental health provider using the BH EHR refers Shally Share to a substance abuse treatment provider in her community and includes the most recent drug toxicology along with other notes.

  • The results are sent in a C-CDA 2.1 "Results" section using "Results Organizer" for the panel and "Result" template for each rest in the panel.
               <entry typeCode="DRIV">
                 <organizer classCode="BATTERY" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.1" extension="2015-08-01"/>
                    <id root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
                    
                    <statusCode code="completed"/>
                    <effectiveTime>
                       <low value="201603190830-0800"/>
                       <high value="201603190830-0800"/>
                    </effectiveTime>
                    <author>
                       
                       <assignedAuthor>
                          <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                          <telecom use="WP" value="tel:555-555-1002"/>
                          <assignedPerson>
                             <name>
                                <given>John</given>
                                <family>Lister</family>
                             </name>
                          </assignedPerson>
                          <representedOrganization>
                             <name>Century Hospital</name>
                          </representedOrganization>
                       </assignedAuthor>
                    </author>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result1"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="23" unit="ug/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="ug/L"/>
                                   <high value="10" unit="ug/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result2"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="0.3" unit="mg/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="mg/L"/>
                                   <high value="0.1" unit="mg/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result3"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="10" unit="ug/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="ug/L"/>
                                   <high value="10" unit="ug/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                                                        
                          
                          <text>
                             <reference value="#result4"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="0" unit="ug/L"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="ng/L"/>
                                   <high value="10" unit="ng/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result5"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="23" unit="mg/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="mg/L"/>
                                   <high value="10" unit="um/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                 </organizer>
              </entry>

Provide Real-time Query for Observations

The BH EHR supports the "Observation" and "Patient" resources to support real-time queries from authorized applications (e.g. consumer-facing, quality reporting, state reporting, etc.).

  • The client application may search by patient and/or by Observation (panel - 24349-3 for "Drugs of abuse 5 panel - Urine") code depending on it purpose
  • The BH EHR would return the matching panels or individual tests

<Observation xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://hl7.org/fhir">
 <id value="121"/>
 <text>...</text>
 <identifier>
   <use value="official"/>
   <system value="urn:observations"/>
   <value value="6324"/>
 </identifier>
 <status value="final"/>
 
   <coding>
     <system value="http://loinc.org"/>
     
     <display value="Drugs of abuse 5 panel - Urine"/>
   </coding>
 
 <subject>
   <reference value="Patient/1234"/>
   <display value="Sally Share"/>
 </subject>
 <effectivePeriod>
   <start value="2016-04-02T10:30:10+01:00"/>
   <end value="2016-04-05T10:30:10+01:00"/>
 </effectivePeriod>
 <issued value="2016-04-03T15:30:10+01:00"/>
 <performer>
   <reference value="Practitioner/2343242"/>
   <display value="John Lister"/>
 </performer>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Amphetamines [Mass/volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="23"/>
     <unit value="ug/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="10"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Benzoylecgonine [Mass/​volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="0.3"/>
     <unit value="mg/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="mg/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="0.1"/>
       <unit value="mg/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Cannabinoids [Mass/​volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="15"/>
     <unit value="ug/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="10"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Phencyclidine [Mass/volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="23"/>
     <unit value="ug/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="10"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
</Observation>

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