Electronic laboratory reporting (ELR) - Issues

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Jurisdictional requirements

• For lab system vendors and labs: States have a variety of reporting formats they require
  • Itemize variations within and among states including sending and receiving organization and system

Message structure

• For states: Labs send message in a variety of formats
  • Itemize variations among submitting labs/vendors
• For states: Labs submit messages in a variety of erroneous or questionable or suboptimal formats, although they may be syntactically correct
• New York State (collect samples of all the conditions below)
  • Some labs submit a multiple-observation message as multiple messages with one observation (OBX) per message
  • some labs submit OBX segments containing information that should be in NTE (Note) segments
  • Some labs submit NTE segments with observation information that should be in OBX segments
  • Some labs use OBX-5 repetitions incorrectly, or at least questionably: simply to chop up a long Text result into short pieces
• Microbiology linkage
  • Most labs don’t do it
    • Some labs even send the drug sensitivity observations in separate messages/files from the organism results: no linkage is possible
  • Of those who do it, none does it completely correctly
  • The 2.5.1 IG is not clear enough about certain requirements
• The HL7 manual is not crystal clear about when OBX-5 repetitions are appropriate and when they aren’t

Terminology

• Placeholder

Implementation

• Discussion between Jimmy Dee and Lily Tatham on PhConnect, ELR CoP forum, and further discussion on the CSI (Collaborative Software Initiative, authors of Utah’s TriSano) forum.
• Not all labs have CLIA codes, e.g. Veterans Administration hospital labs.
• Clem McDonald comments during WG webinar
  • “Implementers don’t like to use Structured Numeric.”
  • “No microbiology lab wants to flag abnormals.”

Harmonization

• How much can we/should we harmonize with IHE profiles?