201601 LabOrderLabReport
Track Name
Laboratory Order and Result
Submitting WG/Project/Implementer Group
Orders and Observations Working Group
todo: See if any implementors interested
Justification
Implementer need:
- Exercise the Request resoure + Action (nee Order) and ActionResponse (nee OrderResponse) resources
- Order with multiple components
- Need to update both Order and OrderResponse with the ability to identify the “activity types” within the overall order being requested/agreed to as well as the number of repetitions agreed to --> e.g cancel, change
- DiagnosticOrder contains a recursive structure of event which is unlike any other request resource in FHIR. One question is whether this can be handled better as a separate requests.
- clarify grouping of observations such as components vs related and diagnostic reports.
Impact on ballot:
The OO workflow recourses DiagnosticOrder, ActionRequest, ActionResponse are the main focus of DSTU 2.1 and the 2106 connectathon. For DiagnosticReport, Observation, and Speicimen, any discovered issues as a result of the connectathon would be balloted as part of DSTU 3.0 see Workflow Discussion
FMM readiness of the resources:
- DiagnosticOrder, Action (nee Order) and ActionResponse (nee OrderResponse) are FMM 1 and FMM 0 respectively - see above for discussion on Impact on ballot for these resources. These resource have not been the topic of any Connectathons to date and need to be exposed to testing to help understand the issues and potential solution for request and workflow resources.
- DiagnosticReport and Observation are FMM3 and would benefit from being the focus of Connectathos to help move them forward to FMM4 as well as identify issues surrounding nested grouping of observation for cases such as culture and sensitivies.
- Specimen resource is FMM1 and has not been supported in any connectathon. This is needed to uncover issues with this immature resource and help move it to FMM2
Proposed Track Lead
Eric M Haas , DVM , MS Health eData Inc
Skype: haas.eric1
Expected participants
Organization:
- Labs? (solicit interested parties)
- LIS Vendors?
- EHR Vendors?
Roles
See | Lab Order Conceptual Model] for details
System Actors from the storyboards above may implement one or more contract roles
FHIR Client ( Laboratory Order Repository )
- Enable the creation and retrieval of the DiagnosticOrder resource operations using the defined basic CRUD operations: create, history, read, search, update and delete.
FHIR Client ( Laboratory fulfillment/LIS )
- Enable the creation and retrieval of the DiagnosticOrder resource operations using the defined basic CRUD operations: create, history, read, search, update and delete.
FHIR Server ( Laboratory Order Repository )
- Support the receiving and processing of the DiagnosticOrder resource operations: create, history, read, search and update.
- Support the receiving and processing of the DiagnosticReport resource operations: create, history, read, search and update.
FHIR Server (Fulfillment System/LIS)
- Support the receiving and processing of the DiagnosticOrder resource operations: create, history, read, search and update.
- Support the receiving and processing of the DiagnosticReport resource operations: create, history, read, search and update.
Scenarios
See | Lab Order Conceptual Model] for details
Storyboard (Universal) - Create Lab Order (Lab Collect)
Eve Everywoman, a 27-year-old female, presents at Good Health Hospital Outpatient Clinic and is seen by Dr. Patricia Primary. Eve reports a history of Anemia and recent, excessive tiredness. Dr. Primary enters a request to check the iron levels in Eve’s blood into her care system. Dr. Primary’s care system then sends the test requests to the lab system at the Good Health Hospital’s Laboratory service. Eve receives a paper order requisition that serves as a reminder, provides instructions for where to find the collection center, and also details preparation instructions for the patient to follow (no food or drink from midnight until collection time on the day of collection). Later that week Eve presents herself at the Lab Collection Center. The lab looks up and finds the order for her testing in the lab system. The appropriate blood samples are extracted, their containers labeled, and the sample information entered into the information in the lab system. The lab performs the analysis on the specimen(s), enters the results into the lab system, and sends the results to Dr. Primary’s care system reported as final. Dr. Primary reviews the results, formulates a treatment, if needed, and notifies Eve Everywoman of the results and treatment.
Steps Scenario 1: Create Lab Order - no workflow
Scenario Assumptions
Simplest Case: (ignoring Specimen collection flow/cancels or updates) Direct exchange of resources. i.e. no workflow resources
Step 1
Action: Completed Diagnostic Order request stored into lab order Repository
Step 2
Action: Diagnostic Orders are pushed/pulled to Fullfillment System/LIS
Step 3
Action: Lab test performed and final Diagnostic report stored in Fullfillment System/LIS
Step 4
Action: Fullfillment System/LIS returns completed DiagnosticReport resources are pushed/pulled to lab report Repository
Steps Scenario Create Lab Order -with workflow
Scenario Assumptions
Simplest Case: (ignoring Specimen collection flow/cancels or updates) Using workflow resources
Step 1
Action: Completed Diagnostic Order request stored into lab order Repository
Step 2
Action: Ordering System polls lab order Repository's for completed Diagnostic Order requests
Step 3
Action: Ordering System creates Action resource (Action.details = DiagnosticOrder resource) are pushed/pulled to Fulfillment System
Step 4
Action: Fulfillment System which responds with ActionResponse resource indicating order accepted
Step 5
Action: Laboratory Information System polls Fulfillment System for accepted lab requests
Step 6
Action: Lab test performed and final Diagnostic report stored in Fullfillment System/LIS
Step 7
Action: Fulfillment System polls Laboratory Information System Repository's for completed Diagnostic Reports
Step 8
Action: Fulfillment System creates/updates ActionResponse resource (ActionRespons.fulfilment = DiagnosticReport resource ) are pushed/pulled to Ordering System
Step 8
Action: Ordering System updates patient record, provider notified??,updated Diagnostic Order request.
:Precondition:
what needs to be in server where etc Has to be some logic or some other party to play the role of fulfiller.
:Success Criteria:
- Requester receives appropriate diagnostic report
- e.g able to query for completed orders and the diagnostic Report.
- Status of Diagnostic Order Action, ActionResponse updated appropriately
:Bonus point:
- Order with multiple components
- cancel/ update order
- split order
- reflex order
- Culture and Sensitivity (complex grouping)
- specimen workflow
TestScript(s)
LabOrderLabReport TestScript Resource
stub for now
