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(Cross-Paradigm Behavioral Health Data Exchange Implementation Guidance) |
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| − | =Cross-Paradigm Behavioral Health (BH) Exchange Project= | + | =Cross-Paradigm Behavioral Health (BH) Data Exchange Project= |
*[http://gforge.hl7.org/gf/project/cbcc/frs/?action=FrsReleaseBrowse&frs_package_id=186 HL7 GForge Release] | *[http://gforge.hl7.org/gf/project/cbcc/frs/?action=FrsReleaseBrowse&frs_package_id=186 HL7 GForge Release] | ||
*Submit feedback using the [http://gforge.hl7.org/gf/project/cbcc/tracker/?action=TrackerItemBrowse&tracker_id=1042 Tracker] | *Submit feedback using the [http://gforge.hl7.org/gf/project/cbcc/tracker/?action=TrackerItemBrowse&tracker_id=1042 Tracker] | ||
==Drug Toxicology Scenario== | ==Drug Toxicology Scenario== | ||
| − | The following is an example scenario intended to illustrate how implementers will use | + | 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 === | ===Drug Toxicology Ordering === | ||
A BH EHR sends a Drug Toxicology Order (as an LOI-conformant V2.5.1 message): | A BH EHR sends a Drug Toxicology Order (as an LOI-conformant V2.5.1 message): | ||
| − | *The | + | * The patient, Sally Share, is treated for PTSD and her provider suspects that she may be suffering a substance use disorder |
| − | *The | + | * 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 | ||
| + | <font color="blue"> | ||
<code> | <code> | ||
| − | <p>'''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 | + | <p> |
| + | '''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 | ||
| + | </p><p>'''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 | ||
| + | </p><p>'''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 | ||
| + | </p><p>'''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 | ||
| + | </p><p>'''DG1'''|1||'''F43.10^Posttraumatic Stress Disorder^I10C'''|||F|||||||||3 | ||
| + | </p><p>'''SPM'''|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||'''122575003^UrineSpecimen^SCT'''|||||||||||||201603190830-0800 | ||
</p> | </p> | ||
| + | </code> | ||
| + | </font> | ||
| + | |||
| + | |||
| + | |||
| + | ===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 <code>'''42860-7^Cannabinoids [Mass/volume] in Urine'''</code> rather than <code>'''52954-5^Cannabinoids [Moles/volume] in Urine'''</code> to analyze the level of Cannabinoids in urine. | ||
| + | <font color="blue"> | ||
| + | <code> | ||
| + | <p> | ||
| + | '''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</p> | ||
<p>'''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</p> | <p>'''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</p> | ||
| − | <p>'''ORC'''| | + | <p>'''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</p> |
<p>'''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</p> | <p>'''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</p> | ||
| − | <p>''' | + | <p>'''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</p> |
| − | <p>'''SPM'''|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||'''122575003^ | + | <p>'''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</p> |
| + | <p>'''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</p> | ||
| + | <p>'''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</p> | ||
| + | <p>'''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</p> | ||
| + | <p>'''SPM'''|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||'''122575003^Urine Specimen^SCT'''|||||||||||||201603190830-0800</p> | ||
</code> | </code> | ||
| − | ===Drug Toxicology Results | + | </font> |
| − | The | + | |
| − | + | ===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"> | ||
| + | <!-- Result organizer template C-CDA 2.1 used to specify a 'Drugs of abuse 5 panel - Urine' panel--> | ||
| + | <templateId root="2.16.840.1.113883.10.20.22.4.1" extension="2015-08-01"/> | ||
| + | <id root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/> | ||
| + | <!-- Drug Toxicology Panel using Results Organizer --> | ||
| + | <code xsi:type="CE" code="24349-3" displayName="Drugs of abuse 5 panel - Urine" | ||
| + | codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> | ||
| + | <statusCode code="completed"/> | ||
| + | <effectiveTime> | ||
| + | <low value="201603190830-0800"/> | ||
| + | <high value="201603190830-0800"/> | ||
| + | </effectiveTime> | ||
| + | <author> | ||
| + | <time value="201603190830-0800"/> | ||
| + | <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"> | ||
| + | <!-- Drug Toxicology Results using Results template --> | ||
| + | <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/> | ||
| + | <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/> | ||
| + | <code xsi:type="CE" code="8150-5" | ||
| + | displayName="Amphetamines [Mass/volume] in Urine" | ||
| + | codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code> | ||
| + | <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> | ||
| + | <time value="201603190830-0800"/> | ||
| + | <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"> | ||
| + | <!-- Drug Toxicology Results using Results template --> | ||
| + | <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/> | ||
| + | <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/> | ||
| + | <code xsi:type="CE" code="3394-4^" | ||
| + | displayName="Benzoylecgonine [Mass/volume] in Urine" | ||
| + | codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code> | ||
| + | <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> | ||
| + | <time value="201603190830-0800"/> | ||
| + | <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"> | ||
| + | <!-- Drug Toxicology Results using Results template --> | ||
| + | <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/> | ||
| + | <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/> | ||
| + | <code xsi:type="CE" code="42860-7" | ||
| + | displayName="Cannabinoids [Mass/volume] in Urine" | ||
| + | codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code> | ||
| + | <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> | ||
| + | <time value="201603190830-0800"/> | ||
| + | <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"> | ||
| + | <!-- Drug Toxicology Results using Results template --> | ||
| + | <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/> | ||
| + | <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/> | ||
| + | <code xsi:type="CE" code="8220-6" | ||
| + | displayName="Opiates [Mass/volume] in Urine" | ||
| + | codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> | ||
| + | </code> | ||
| + | <text> | ||
| + | <reference value="#result4"/> | ||
| + | </text> | ||
| + | <statusCode code="completed"/> | ||
| + | <value xsi:type="PQ" value="0" unit="ug/L"/> | ||
| + | <methodCode/> | ||
| + | <targetSiteCode/> | ||
| + | <author> | ||
| + | <time value="201603190830-0800"/> | ||
| + | <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"> | ||
| + | <!-- Drug Toxicology Results using Results template --> | ||
| + | <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/> | ||
| + | <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/> | ||
| + | <code xsi:type="CE" code="3937-0" | ||
| + | displayName="Phencyclidine [Mass/volume] in Urine" | ||
| + | codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code> | ||
| + | <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> | ||
| + | <time value="201603190830-0800"/> | ||
| + | <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 | ||
| + | <font color="blue"> | ||
| + | <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"/> | ||
| + | <code> | ||
| + | <coding> | ||
| + | <system value="http://loinc.org"/> | ||
| + | <code value="'''24349-3'''"/> | ||
| + | <display value="'''Drugs of abuse 5 panel - Urine'''"/> | ||
| + | </coding> | ||
| + | </code> | ||
| + | <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> | ||
| + | <code> | ||
| + | <coding> | ||
| + | <system value="http://loinc.org"/> | ||
| + | <code value="'''8150-'''5"/> | ||
| + | <display value="'''Amphetamines [Mass/volume] in Urine'''"/> | ||
| + | </coding> | ||
| + | </code> | ||
| + | <valueQuantity> | ||
| + | <value value="23"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </valueQuantity> | ||
| + | <referenceRange> | ||
| + | <low> | ||
| + | <value value="0"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </low> | ||
| + | <high> | ||
| + | <value value="10"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </high> | ||
| + | </referenceRange> | ||
| + | </component> | ||
| + | <component> | ||
| + | <code> | ||
| + | <coding> | ||
| + | <system value="http://loinc.org"/> | ||
| + | <code value="'''3394-4'''"/> | ||
| + | <display value="'''Benzoylecgonine [Mass/volume] in Urine'''"/> | ||
| + | </coding> | ||
| + | </code> | ||
| + | <valueQuantity> | ||
| + | <value value="0.3"/> | ||
| + | <unit value="mg/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="mg/L"/> | ||
| + | </valueQuantity> | ||
| + | <referenceRange> | ||
| + | <low> | ||
| + | <value value="0"/> | ||
| + | <unit value="mg/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="mg/L"/> | ||
| + | </low> | ||
| + | <high> | ||
| + | <value value="0.1"/> | ||
| + | <unit value="mg/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="mg/L"/> | ||
| + | </high> | ||
| + | </referenceRange> | ||
| + | </component> | ||
| + | <component> | ||
| + | <code> | ||
| + | <coding> | ||
| + | <system value="http://loinc.org"/> | ||
| + | <code value="'''42860-7'''"/> | ||
| + | <display value="'''Cannabinoids [Mass/volume] in Urine'''"/> | ||
| + | </coding> | ||
| + | </code> | ||
| + | <valueQuantity> | ||
| + | <value value="15"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </valueQuantity> | ||
| + | <referenceRange> | ||
| + | <low> | ||
| + | <value value="0"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </low> | ||
| + | <high> | ||
| + | <value value="10"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </high> | ||
| + | </referenceRange> | ||
| + | </component> | ||
| + | <component> | ||
| + | <code> | ||
| + | <coding> | ||
| + | <system value="http://loinc.org"/> | ||
| + | <code value="'''3937-0'''"/> | ||
| + | <display value="'''Phencyclidine [Mass/volume] in Urine'''"/> | ||
| + | </coding> | ||
| + | </code> | ||
| + | <valueQuantity> | ||
| + | <value value="23"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </valueQuantity> | ||
| + | <referenceRange> | ||
| + | <low> | ||
| + | <value value="0"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </low> | ||
| + | <high> | ||
| + | <value value="10"/> | ||
| + | <unit value="ug/L"/> | ||
| + | <system value="http://unitsofmeasure.org"/> | ||
| + | <code value="ug/L"/> | ||
| + | </high> | ||
| + | </referenceRange> | ||
| + | </component> | ||
| + | </Observation> | ||
| + | </font> | ||
[[Category:Work_Group]] | [[Category:Work_Group]] | ||
[[Category:Domain_Experts_Steering_Division]] | [[Category:Domain_Experts_Steering_Division]] | ||
[[Category:CBCC]] | [[Category:CBCC]] | ||
Latest revision as of 17:28, 4 August 2016
Cross-Paradigm Behavioral Health (BH) Data Exchange Project
- HL7 GForge Release
- Submit feedback using the Tracker
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"/>
<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"/><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><display value="Drugs of abuse 5 panel - Urine"/> </coding><coding> <system value="http://loinc.org"/><valueQuantity> <value value="23"/> <unit value="ug/L"/> <system value="http://unitsofmeasure.org"/><display value="Amphetamines [Mass/volume] in Urine"/> </coding></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"/><valueQuantity> <value value="0.3"/> <unit value="mg/L"/> <system value="http://unitsofmeasure.org"/><display value="Benzoylecgonine [Mass/volume] in Urine"/> </coding></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"/><valueQuantity> <value value="15"/> <unit value="ug/L"/> <system value="http://unitsofmeasure.org"/><display value="Cannabinoids [Mass/volume] in Urine"/> </coding></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"/><valueQuantity> <value value="23"/> <unit value="ug/L"/> <system value="http://unitsofmeasure.org"/><display value="Phencyclidine [Mass/volume] in Urine"/> </coding></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>
