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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 resource + 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 Specimen, 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 Connectathon 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 Connectathon to help move them forward to FMM4 as well as identify issues surrounding nested grouping of observation for cases such as culture and sensitivity.
  • 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

President Health eData Inc

Eric Haas

Skype: haas.eric1

Expected participants

Organization:

  • National/Regional 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 ( Order Management Interface/EHR-S )

(note: The Order Management Interface Client may be realized by various Actors as illustrated above)

  • Create and retrieve the DiagnosticOrder resource using the defined basic CRUD operations: create, history, read, search, update and delete.
  • Retrieve the DiagnosticResponse resource using the defined basic CRUD operations: history, read, search,
  • Create and retrieve the Action/Order resource using the defined basic CRUD operations: create, history, read, search, update and delete.
  • Retrieve the ActionResponse/OrderResponse resource using the defined basic CRUD operations: history, read, search,


FHIR Server ( Order Management Interface/EHR-S )

(note: The Order Management Interface Server may be realized by various Actors as illustrated above)

  • 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: history, read, search.
  • Support the receiving and processing of the Action/Order resource operations: create, history, read, search and update.
  • Support the receiving and processing of the ActionResponse/OrderResponse resource operations: history, read, search.


FHIR Client ( Fulfillment System/LIS )

(note: The Order Fulfillment Management Interface Client may be realized by various Actors as illustrated above)

  • Create and retrieve the ActionResponse/OrderResponse resource using the defined basic CRUD operations: create, history, read, search, update and delete.
  • Retrieve the Action/Order resource using the defined basic CRUD operations: history, read, search,
  • Create and retrieve the DiagnosticReport resource using the defined basic CRUD operations: create, history, read, search, update and delete.
  • Retrieve the DiagnosticOrder resource using the defined basic CRUD operations: history, read, search

FHIR Server (Fulfillment System/LIS)

(note: The Order Fulfillment Management Interface Server may be realized by various Actors as illustrated above)

  • Support the receiving and processing of the OrderResponse/ActionResponse resource operations: create, history, read, search and update.
  • Support the receiving and processing of the Order/Action resource operations: history, read, search
  • Support the receiving and processing of the DiagnosticOrder resource operations: history, read, search
  • Support the receiving and processing of the DiagnosticReport resource operations: create, history, read, search and update.

Scenarios

1. Create Lab Order (Lab Collect) no Workflow resources

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.


Scenario Assumptions

Simplest Case:

FulfillmentLiteSTM.PNG

Ignoring Specimen collection flow/cancels or updates

Direct exchange of resources between LabOrderRepository and LIS i.e. no workflow or fulfillment system actors or resources

Non target resources Patient, Organization and Practitioner will be fixed (default).

A limited set of 4-5 potential tests to order will be provided and corresponding results applied.

Either XML or JSON formats to be supported.

Step 1a

Action: FHIR Client ( Order Management Interface/EHR-S ) creates completed DiagnosticOrder request and save to Order Management Interface/EHR-S

Precondition: DiagnosticOrder does not exist in service prior to action

Success Criteria: DiagnosticOrder created correctly on server (use browser to inspect)

Bonus point:

  • Order with multiple components
  • Progression from proposed to completed order
  • cancel/update order
  • Add Specimen collection

>>Note: the resource Id can either be created by the client or the server (depending on the capability of the server). However, if the server assigns the Id, then the client will need to be able to retrieve the Id from the server response or by a query.

Step 1b

Action: FHIR Client ( Order Management Interface/EHR-S ) pushes copy of completed DiagnosticOrder request to Fulfillment System/LIS.

Precondition: DiagnosticOrder does not exist in Fulfillment System/LIS prior to action

Success Criteria: DiagnosticOrder created correctly on server (use browser to inspect)

Bonus point:

  • cancel/update order
  • server to server transaction

Step 1c

Action: FHIR Server (Fulfillment System/LIS) receives and stores copy of completed DiagnosticOrder and send a transaction response with payload of updated DiagnosticOrder with status of "accepted" or "rejected" based on a simple criteria of whether:

  1. the test orders matches test catalog.
  2. able to identify the patient
  3. able to identify to placer

Response payload will be update Diagnostic Order with updated status of "accepted"or "rejected"

Success Criteria: copy of DiagnosticOrder received stored and updated and returned as part of transaction appropriately with status of "accepted". (use browser to inspect)

Bonus point:

  • negative testing - order rejection
  • cancel/update order

Step 1d

Action: FHIR Client ( Lab Order Repository ) searches and pulls finalDiagnosticReport resources from FHIR Server (LIS) and creates copy in Laboratory Order Repository.

Precondition:completed DiagnosticRequest does not exist in service prior to action

Success Criteria: copy of DiagnosticReport in FHIR Server (LIS) (use browser to inspect)

Bonus point:

  • Culture and Sensitivity (complex grouping,roundtrip workflow)

Scenario 1 RoundTrip Success Criteria:

DiagnosticReport is appropriate for DiagnosticOrder.

Scenario 1 Round Trip Bonus point

  • Order with multiple components (roundtrip workflow)
  • cancel/update order (roundtrip workflow)
  • split order (roundtrip workflow)
  • reflex order (roundtrip workflow)
  • Culture and Sensitivity (complex grouping,roundtrip workflow)
  • Add Specimen collection (roundtrip workflow)

2. Create Lab Order (Lab Collect) using Workflow resources

See | Lab Order Conceptual Model] for details

See Storyboard above

Scenario Assumptions

Simplest Case: (ignoring Specimen collection flow/cancels or updates) Using workflow resources

Step 2a

Action: Completed Diagnostic Order request stored into lab order Repository

Precondition:

Success Criteria:

Bonus point:

Step 2b

Action: Ordering System polls lab order Repository's for completed Diagnostic Order requests

Precondition:

Success Criteria:

Bonus point:

Step 2c

Action: Ordering System creates Action resource (Action.details = DiagnosticOrder resource) are pushed/pulled to Fulfillment System

Precondition:

Success Criteria:

Bonus point:

Step 2d

Action: Fulfillment System which responds with ActionResponse resource indicating order accepted

Precondition:

Success Criteria:

Bonus point:

Step 2e

Action: Laboratory Information System polls Fulfillment System for accepted lab requests

Precondition:

Success Criteria:

Bonus point:

Step 2f

Action: Lab test performed and final Diagnostic report stored in Fullfillment System/LIS

Precondition:

Success Criteria:

Bonus point:

Step 2g

Action: Fulfillment System polls Laboratory Information System Repository's for completed Diagnostic Reports

Precondition:

Success Criteria:

Bonus point:

Step 2h

Action: Fulfillment System creates/updates ActionResponse resource (ActionRespons.fulfilment = DiagnosticReport resource ) are pushed/pulled to Ordering System

Precondition:

Success Criteria:

Bonus point:

Step 2i

Action: Ordering System updates patient record, provider notified??,updated Diagnostic Order request.

Precondition:

Success Criteria:

Bonus point:



3. 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 3a

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

Precondition:

Success Criteria:

Bonus point:

Step 3b

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

Precondition:

Success Criteria:

Bonus point:

Step 3c

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

Precondition:

Success Criteria:

Bonus point:

Step 3d

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

Precondition:

Success Criteria:

Bonus point:

Step 3e

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


Precondition:

Success Criteria:

Bonus point:

Bonus Points

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

TestScript(s)

LabOrderLabReport TestScript Resource

stub for now

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