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201601 LabOrderLabReport

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Track Name

Laboratory Order and Result

Submitting WG/Project/Implementer Group

Orders and Observations Working Group (Service-oriented Architecture will support a component of this track)

todo: See if any implementors interested

Justification

Implementer need:

  1. 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
  2. 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.
  3. 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

[| Eric Haas]

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

ActorContractRole.png

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:

  1. Requester receives appropriate diagnostic report
    • e.g able to query for completed orders and the diagnostic Report.
  2. 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


Steps Scenario SOA Example Medication Order with Workflow

Scenario Assumptions

Simplest Case: (Short form to determine which ordering system; dynamic discovery via orderables lookup) Using workflow resources

Step 1

Action: End-user facing form to select a provider organzation (e.g., which ordering system)

Step 2

Action: Evaluate user form to determine which system and which disease condition hence determining drug class and route

Step 3

Action: Orchestrator module to call the candidate system doing an orderables lookup for the corresponding drug on formulary

Step 4

Action: Orchestrator chooses drug. Makes service call to ordering system to place drug order.

Step 5

Repeat the above, choosing a different organization in the user-facing form resulting in drug order from a different system - no hardcoding.


Bonus Points

Repeat the above, altering disease and hence dynamically adjusting drug ordered.


TestScript(s)

LabOrderLabReport TestScript Resource

stub for now