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Difference between revisions of "Electronic laboratory reporting (ELR) - Issues"
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**The 2.5.1 IG is not clear enough about certain requirements | **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 | *The HL7 manual is not crystal clear about when OBX-5 repetitions are appropriate and when they aren’t | ||
| + | |||
| + | ==Proposed improvements to the IG== | ||
| + | *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. Discussion is about how confusing the IG is and how hard to find what you want to know. Will track down links. | ||
| + | *Clarify the 2.3.1 message/data model diagram | ||
| + | *What does "required" really mean from a receiver's point of view? From a practical point of view, any receiver can ignore any incoming data they want. | ||
==Terminology== | ==Terminology== | ||
* different data exchanges may request different terminology including aggregated or rolled-up information; this may lead to different terminology requirements depending upon the receiving system's exchange requirements. How can or should this be handled? | * different data exchanges may request different terminology including aggregated or rolled-up information; this may lead to different terminology requirements depending upon the receiving system's exchange requirements. How can or should this be handled? | ||
* many, if not most, of the current terminology practices place the onus for terminology mapping and transformation on the Senders; is this a best practice to be continued or should some of the onus be placed on the Receivers and/or other elements within the data exchange architecture such as RHIOs and/or HIEs? | * many, if not most, of the current terminology practices place the onus for terminology mapping and transformation on the Senders; is this a best practice to be continued or should some of the onus be placed on the Receivers and/or other elements within the data exchange architecture such as RHIOs and/or HIEs? | ||
| + | *Conformance profile terminology, e.g. "Required but may be empty"* | ||
==Implementation== | ==Implementation== | ||
| − | |||
*Not all labs have CLIA codes, e.g. Veterans Administration hospital labs. | *Not all labs have CLIA codes, e.g. Veterans Administration hospital labs. | ||
*Clem McDonald comments during WG webinar | *Clem McDonald comments during WG webinar | ||
Revision as of 16:27, 7 January 2011
Contents
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
- Most labs don’t do it
- The HL7 manual is not crystal clear about when OBX-5 repetitions are appropriate and when they aren’t
Proposed improvements to the IG
- 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. Discussion is about how confusing the IG is and how hard to find what you want to know. Will track down links.
- Clarify the 2.3.1 message/data model diagram
- What does "required" really mean from a receiver's point of view? From a practical point of view, any receiver can ignore any incoming data they want.
Terminology
- different data exchanges may request different terminology including aggregated or rolled-up information; this may lead to different terminology requirements depending upon the receiving system's exchange requirements. How can or should this be handled?
- many, if not most, of the current terminology practices place the onus for terminology mapping and transformation on the Senders; is this a best practice to be continued or should some of the onus be placed on the Receivers and/or other elements within the data exchange architecture such as RHIOs and/or HIEs?
- Conformance profile terminology, e.g. "Required but may be empty"*
Implementation
- 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.”
Architecture
- Different senders (labs) have different software systems, modules, and/or packages available, some of these have been provided by vendors and some are "home-grown". What candidate architectures are in use and what are the benefits of each architecture?
Harmonization
- How much can we/should we harmonize with IHE profiles?
