Lab Order Template

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Scope of Lab Order Template (ID: 587)

To develop specifications and models for communicating orders for laboratory (specimen-based) testing using the new, alpha, just developed, Service Aware Architecture Framework (SAIF). SAIF specification is at the conceptual or canonical description level; currently there is no v3 SAIF Implementation Guide for HL7. Therefore, the work in this laboratory conceptual specification is best-guess and alpha-level thinking. The project team believe the current artifacts thoroughly describe the interoperability space for laboratory order; however, those exact artifacts are not necessarily the artifacts that will eventually be contained and defined by the SAIF IG and are presented as draft and present for your consideration.

Leadership

Co-Chair, Project Facilitator, Modeling Facilitator: Patrick Loyd; 415-246-7441, patrick.e.loyd@gmail.com

Modeling, SOA Facilitator: Lorraine Constable; lorraine@constable.ca

Documentation

Link to the current document:

• Laboratory Order Conceptual Specification (Draft)

Most Current Conceptual Specification To Dos and Open Issues

• May 2013 WGM - To Dos
  • Update conceptual specification from reconciliation comments
  • Add requirements to EA
  • How do we integrate with the Order Services project?
  • What's up with Artifact Definition Project (currently not making progress)?
  • When can we start talking about wrapper requirements which need to change as a result of the new behavioral framework?
  • What's next? Requirements (which will drive conformance statements), then RMIM for Lab Order

• September 2012 WGM - Discussion Issues
  • Challenge the following: Add query to first step for change order event flow
  • Challenge/confirm Assmption: All systems are connected.
    • should we instead make assumption that there is a repository? Currently, planning on handling architecture with repository as an alt flow.
  • Challenge/confirm Assumption: unsuitable specimens are 'resulted' and captured as an assumption and alt flow
  • Process Actors - primary/secondary
  • Review how we should reflect push/pull variations in the interactions between order manager and specimen, and fulfiller and order manager

• September 2012 WGM - Prep
  • Pick a term - either revise, update, or modify - Patrick (DONE)
    • Interestingly - Patrick picked the term 'change'; so we now are using create, change, and cancel
  • Update the interaction diagrams to add the specimen collection - Lorraine (DONE)
  • Add process framework - Patrick (DONE)
  • Add identifiers to all activities on the activity diagrams - Patrick (DONE)
  • Clean up specimen evaluation section of both activity diagrams - Patrick (DONE)

Past Conceptual Specification To Dos and Open Issues

• September 2011 WGM
  • Create conceptual datatypes for items needed by conceptual models (done)
  • Review model interactions for consistency
  • Consider naming conventions for parts of the artifacts, and identifiers
  • Add the business context text to the use cases, and to the service specifications
• January 2012 WGM
  • Review package structure and how to relate composite order model to lab models
  • Consider whether need a different package view for publishing purposes from working structure
  • Create Service-Specification Template of the spec documentation structure
  • Clean up state machines
    • Fulfillment or In progress
  • Create a communication diagram as an alternative to the sequence (determined not to do at this time)
  • Review of event flow
    • Clarify activity currently called "Patient Presents at Lab" to indicate that they are not actually presenting at the lab, maybe Patient Service Center, or just Patient Presents (done)
    • Expand lab activities to include steps like evaluating sample for suitability and notifying if rejected (done)
    • Expand diagram for the simple acute case where the collector goes to the patient (done)
    • Add a storyboard for the simple acute case where the collector goes to the patient (done)
    • Add a storyboard for the provider collects the specimen (done)
• May 2012 WGM - Prep
  • separate interaction diagrams into two - one for each path in event flow - Lorraine (reviewed, and interaction diagram remains the same)
  • edit interaction to remove point of service - Lorraine (done)
  • provide trace between analysis actors and the contract roles - Lorraine (done)
  • plan call to create service scope verbiage - Lorraine
  • create second scenario for modify/cancel flow - Lorraine (modify done - cancel separate)
  • document conformance statements in scenarios and contract interfaces - Lorraine
  • Create modify/delete event flow - Patrick (modify flow created, still need to create delete flow)
  • Fix swimlane problem in current create lab order event flow (lab repository is extra) - Patrick (in progress)
  • Remove extra bits no longer used in the event flow - Patrick (in progress)
  • Remove activity diagram from use cases, remove redirect too - Patrick

May 2012 WGM

• Discussed the role of a central lab repository in the third storyboard
• Discussion of future orders - once an order has been pushed to a lab repository - how long should it remain active if the patient does not show up?
• Reviewed the Modify Order event flow
  • request modification of a previous event flow - include precondition that the Order must still be active to be modified (ie - has not been resulted yet
  • consider cancel and replace of an existing order
  • in a specimen centric point of view, there is an alternate flow for modifying an order after resulting. Discussed whether this is a new order on an existing specimen or a modify order
  • need to capture screening use cases where specimen drawn is regulated to contain enough volume for the initial screening test and the subsequent confirmation test (this is a case of reflex testing?)
  • need to handle lab created order.
  • reorganize event flow package to separate create and revise
  • need the use case from J Harrison to describe the situation where the lab modifies the order
• Reviewed conceptual state machine
  • Ken noted, that based on CAP requirement, added additional result statues for 2.8 to cover amended, confirmed, appended in addition to the previous status list
• Comments from Cindy V.:
  • Conceptual Roles: I suggest changing “healthcare information” in the description for the 2 systems to “laboratory information”.
    • PEL> Agree with change to Lab System actor. Will make the change (done)
    • PEL> Do not agree with change to POS system. That actor is more general and available to everyone, not just lab. the intent of SAIF is to create re-usable bits. Overspecifying causes to lose this.
  • Conceptual State Model: I think it would be helpful to have a state model in the storyboards or before the comprehensive state model. This would fill in the gaps and help show the derivation of “the following request object states and transitions from the above storyboards”.
    • Agree. Will add storyboard specific state machines for understandability as well as 'master' state machine
  • Conceptual State Model: The paragraph after the 1st state model starts “As you can see, the request object”. Frankly, I cannot see how the state model tracks from the storyboards. In addition, you use different terms in the state model such as fulfiller, fulfillment resolution, etc. that aren’t defined or, otherwise, explained.
    • Agree. Wording is left over from requirements document. Will reword accordingly.
  • In Contract Roles and Agents, you are using different terms for the Commissioning System Role and the Responsible System Role without linking them to the terms in the event flow (Provider Order Management System: Ordering System, Laboratory Point of Service System: Specimen Collector System, & Laboratory: Laboratory Information System). It would help in reading the more system-centric diagrams if this connection was made.
    • Agree. Will align.
• Considerations for future use:
  • will need conceptual roles for devices once we model results
  • lab to lab orders for referral and redirects

RMIM To Dos

• Criterion mood to an attribute (preconditions)
• Lab order is a proper subset of composite order (in two weeks)
  • composite order missing:
  • data enterer.modeCode
  • informationrecipient.sequenceNumber, info.rcpt.time
  • we are not using consistent sequenceNumber, should be there for all AR and Part where the min cardinality is 1 or higher
  • add subject to lab
  • lab order need location (yes)
  • should composite have reasonCode on placerGroup>?
  • update composite obs req and lab obs req for new negation ind
  • lab obs request, status must be mandatory
  • composite order, why ActDefinition.text (esp. as optional)
  • lab prioractrequest, remove code, text, correct spelling 'o'bsolete (lower case 'o')
  • does lab need preconidition

Completed RMIM To Dos

• Review 'old' context conduction - DONE (PEL 20110911)
• look at whether PatientorAssigned should still use R-assignedEntity - No change (PEL 20110911)
• bring up to date to the current RIM - DONE (PEL 20110911)
• Replace supporting clinical information CMET with supporting clinical statement
• Replace annotation with annotation cmet
• Add event to fulfillment AR
• replace lab process step with process step cmet

Future

Add more use cases:

• Order cannot be processed due to missing information

Links

IHE Laboratory-Clinical Communication Profile (LCC). Use cases and transaction patterns supporting laboratory order modification and results verification.