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Difference between revisions of "Cross-Paradigm Behavioral Health Exchange Project"

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(Cross-Paradigm Behavioral Health Data Exchange Implementation Guidance)
 
 
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=Cross-Paradigm Behavioral Health (BH) Exchange Project=
+
=Cross-Paradigm Behavioral Health (BH) Data Exchange Project=
 
*[http://gforge.hl7.org/gf/project/cbcc/frs/?action=FrsReleaseBrowse&frs_package_id=186 HL7 GForge Release]
 
*[http://gforge.hl7.org/gf/project/cbcc/frs/?action=FrsReleaseBrowse&frs_package_id=186 HL7 GForge Release]
 
*Submit feedback using the [http://gforge.hl7.org/gf/project/cbcc/tracker/?action=TrackerItemBrowse&tracker_id=1042 Tracker]
 
*Submit feedback using the [http://gforge.hl7.org/gf/project/cbcc/tracker/?action=TrackerItemBrowse&tracker_id=1042 Tracker]
  
 
==Drug Toxicology Scenario==
 
==Drug Toxicology Scenario==
The following is an example scenario intended to illustrate how implementers will use  
+
The following is an example scenario intended to illustrate how implementers will use HL7 V2.5.1 for lab orders and result reporting, C-CDA documents, and FHIR resource to convey drug toxicology information for a patient receiving treatment for PTSD (ICD-10 F43.10).
 +
 
 +
*24349-3  Drugs of abuse 5 panel - Urine
 +
**8150-5: Amphetamines [Mass/volume] in Urine (ug/L)
 +
**3394-4: Benzoylecgonine [Mass/volume] in Urine (mg/L)
 +
**42860-7: Cannabinoids [Mass/volume] in Urine (ug/L)
 +
**8220-6: Opiates [Mass/volume] in Urine (ng/L)
 +
**3937-0: Phencyclidine [Mass/volume] in Urine (ug/L)
 +
 
 +
 
 +
 
 
===Drug Toxicology Ordering ===
 
===Drug Toxicology Ordering ===
 
A BH EHR sends a Drug Toxicology Order (as an LOI-conformant  V2.5.1 message):
 
A BH EHR sends a Drug Toxicology Order (as an LOI-conformant  V2.5.1 message):
*The drug toxicology panel  (24349-3^Drugs of abuse 5 panel - Urine) is supported by the laboratory
+
* The patient, Sally Share, is treated for PTSD and her provider suspects that she may be suffering a substance use disorder
*The order references the specimen (urine)
+
* The provider order a toxicology panel  (24349-3^Drugs of abuse 5 panel - Urine) for Sally Share from a local laboratory
 +
* The provider collects the specimen (urine) and sends to the laboratory - a reference to the specimen is included in the order
 +
<font color="blue">
 
<code>
 
<code>
<p>'''MSH'''|^~\&|BH-EHR^2.16.840.1.113883.3.72.5.22^ISO|EHR Facility^2.16.840.1.113883.3.72.5.23^ISO|Reference Laboratory^2.16.840.1.113883.3.72.5.20^ISO|Lab Facility^2.16.840.1.113883.3.72.5.21^ISO|20160211184101-0500||OML^O21^OML_O21|NIST-LOI_8.0_1.1-GU|T|2.5.1|||AL|NE|||||LOI_Common_Component^LOI Base Profile^2.16.840.1.113883.9.66^ISO~LOI_GU_Component^LOI GU Profile^2.16.840.1.113883.9.78^ISO~LAB_PRU_Component^LOI PRU Profile^2.16.840.1.113883.9.82^ISO
+
<p>
 +
'''MSH'''|^~\&|BH-EHR^2.16.840.1.113883.3.72.5.22^ISO|EHR Facility^2.16.840.1.113883.3.72.5.23^ISO|Reference Laboratory^2.16.840.1.113883.3.72.5.20^ISO|Lab Facility^2.16.840.1.113883.3.72.5.21^ISO|20160211184101-0500||OML^O21^OML_O21|NIST-LOI_8.0_1.1-GU|T|2.5.1|||AL|NE|||||LOI_Common_Component^LOI Base Profile^2.16.840.1.113883.9.66^ISO~LOI_GU_Component^LOI GU Profile^2.16.840.1.113883.9.78^ISO~LAB_PRU_Component^LOI PRU Profile^2.16.840.1.113883.9.82^ISO
 +
</p><p>'''PID'''|1||PATID1234^^^&2.16.840.1.113883.3.72.5.30.2&ISO^MR||'''Share^Sally^A^^^^L'''||19281011|F||2106-3^White^HL70005|1500 Patient Way^Apt 4^Huntington Park^CA^90255^^H|||||||||||H^Hispanic^HL70189
 +
</p><p>'''ORC'''|NW|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||ORD798642^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO|||||20160124||57422^Hippocrates^Harold|57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^^PH^^^626^9876543^1||||||2^Patient has been informed of responsibility, and agrees to pay for service^HL70339
 +
</p><p>'''OBR'''|1|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||'''24349-3^Drugs of abuse 5 panel - Urine^LN'''|||201603190830-0800|||||||||57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^^PH^^^626^9876543^1
 +
</p><p>'''DG1'''|1||'''F43.10^Posttraumatic Stress Disorder^I10C'''|||F|||||||||3
 +
</p><p>'''SPM'''|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||'''122575003^UrineSpecimen^SCT'''|||||||||||||201603190830-0800
 
</p>
 
</p>
 +
</code>
 +
</font>
 +
 +
 +
 +
===Drug Toxicology Results Reporting===
 +
The laboratory receives the specimen from the BH provider and performs the tests specified in the panel definition (http://s.details.loinc.org/LOINC/24349-3.html?sections=Simple). The lab transmits the Lab Results message (LRI conformance V2.5.1 message) to the BH EHR to be reviewed and interpreted by the provider.
 +
The example results transactions  are using <code>'''42860-7^Cannabinoids [Mass/​volume] in Urine'''</code> rather than  <code>'''52954-5^Cannabinoids [Moles/volume] in Urine'''</code> to analyze the level of Cannabinoids in urine.
 +
<font color="blue">
 +
<code>
 +
<p>
 +
'''MSH'''|^~\&|Reference Laboratory^2.16.840.1.113883.3.72.5.20^ISO|Lab Facility^2.16.840.1.113883.3.72.5.21^ISO|BH-EHR^2.16.840.1.113883.3.72.5.22^ISO|EHR Facility^2.16.840.1.113883.3.72.5.23^ISO|20160601140551-0500||ORU^R01^ORU_R01|NIST-LRI-GU-002.00|T|2.5.1|||AL|NE|||||LRI_Common_Component^^2.16.840.1.113883.9.16^ISO~LRI_GU_Component^^2.16.840.1.113883.9.12^ISO~LRI_RU_Component^^2.16.840.1.113883.9.14^ISO</p>
 
<p>'''PID'''|1||PATID1234^^^&2.16.840.1.113883.3.72.5.30.2&ISO^MR||'''Share^Sally^A^^^^L'''||19281011|F||2106-3^White^HL70005|1500 Patient Way^Apt 4^Huntington Park^CA^90255^^H|||||||||||H^Hispanic^HL70189</p>
 
<p>'''PID'''|1||PATID1234^^^&2.16.840.1.113883.3.72.5.30.2&ISO^MR||'''Share^Sally^A^^^^L'''||19281011|F||2106-3^White^HL70005|1500 Patient Way^Apt 4^Huntington Park^CA^90255^^H|||||||||||H^Hispanic^HL70189</p>
<p>'''ORC'''|NW|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||ORD798642^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO|||||20160124||57422^Hippocrates^Harold|57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^^PH^^^626^9876543^1||||||2^Patient has been informed of responsibility, and agrees to pay for service^HL70339</p>
+
<p>'''ORC'''|RE|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||ORD798642^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO|||||20160124||57422^Hippocrates^Harold|57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^^PH^^^626^9876543^1||||||2^Patient has been informed of responsibility, and agrees to pay for service^HL70339</p>
 
<p>'''OBR'''|1|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||'''24349-3^Drugs of abuse 5 panel - Urine^LN'''|||201603190830-0800|||||||||57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^^PH^^^626^9876543^1</p>
 
<p>'''OBR'''|1|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||'''24349-3^Drugs of abuse 5 panel - Urine^LN'''|||201603190830-0800|||||||||57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^^PH^^^626^9876543^1</p>
<p>'''DG1'''|1||'''F43.10^Posttraumatic Stress Disorder^I10C'''|||F|||||||||3</p>
+
<p>'''OBX'''|1|NM|'''8150-5^Amphetamines [Mass/volume] in Urine^LN'''||'''23|ug/L^micrograms per liter^UCUM'''|0 to 10|H|||F|||20160103143428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN</p>
<p>'''SPM'''|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||'''122575003^UrineSpecimen^SCT'''|||||||||||||201603190830-0800</p>
+
<p>'''OBX'''|2|NM|'''3394-4^Benzoylecgonine [Mass/​volume] in Urine^LN'''||'''0.3|mg/L^milligrams per liter^UCUM|0 to 0.1|H'''|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN</p>
 +
<p>'''OBX'''|3|NM|'''42860-7^Cannabinoids [Mass/​volume] in Urine^LN'''||'''15|ug/L^micrograms per liter^UCUM|0 to 10|H'''|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN</p>
 +
<p>'''OBX'''|4|NM|'''8220-6^Opiates [Mass/​volume] in Urine^LN'''||'''0|ng/L^nanograms per liter^UCUM|0 to 10|N'''|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN</p>
 +
<p>'''OBX'''|5|NM|'''3937-0^Phencyclidine [Mass/​volume] in Urine^LN'''||'''23|ug/L^micrograms per liter^UCUM|0 to 10|H'''|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN</p>
 +
<p>'''SPM'''|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||'''122575003^Urine Specimen^SCT'''|||||||||||||201603190830-0800</p>
 
</code>
 
</code>
===Drug Toxicology Results Reporting===
+
</font>
The laboratory receives the specimen from the BH provider and performs the tests specified in the panel definition (http://s.details.loinc.org/LOINC/24349-3.html?sections=Simple). The lab transmits the Lab Results message (LRI conformance V2.5.1 message) to the BH EHR to be reviewed and interpreted by the provider.
+
 
The example results transactions  are using '''42860-7^Cannabinoids [Mass/​volume] in Urine''' rather than  '''52954-5^Cannabinoids [Moles/volume] in Urine''' to analyze the level of Cannabinoids in urine.
+
===Send Drug Toxicology Results in a Referral Document to Substance Abuse Treatment Provider===
 +
The mental health provider using the BH EHR refers Shally Share to a substance abuse treatment provider in her community and includes the most recent drug toxicology along with other notes.
 +
*The results are sent in a C-CDA 2.1 "Results" section using "Results Organizer" for the panel and "Result" template for each rest in the panel.
 +
 
 +
                <entry typeCode="DRIV">
 +
                  <organizer classCode="BATTERY" moodCode="EVN">
 +
                    <!-- Result organizer template C-CDA 2.1 used to specify a 'Drugs of abuse 5 panel - Urine' panel-->
 +
                    <templateId root="2.16.840.1.113883.10.20.22.4.1" extension="2015-08-01"/>
 +
                    <id root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
 +
                    <!-- Drug Toxicology Panel using Results Organizer -->
 +
                    <code xsi:type="CE" code="24349-3" displayName="Drugs of abuse 5 panel - Urine"
 +
                        codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
 +
                    <statusCode code="completed"/>
 +
                    <effectiveTime>
 +
                        <low value="201603190830-0800"/>
 +
                        <high value="201603190830-0800"/>
 +
                    </effectiveTime>
 +
                    <author>
 +
                        <time value="201603190830-0800"/>
 +
                        <assignedAuthor>
 +
                          <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
 +
                          <telecom use="WP" value="tel:555-555-1002"/>
 +
                          <assignedPerson>
 +
                              <name>
 +
                                <given>John</given>
 +
                                <family>Lister</family>
 +
                              </name>
 +
                          </assignedPerson>
 +
                          <representedOrganization>
 +
                              <name>Century Hospital</name>
 +
                          </representedOrganization>
 +
                        </assignedAuthor>
 +
                    </author>
 +
                    <component>
 +
                        <observation classCode="OBS" moodCode="EVN">
 +
                          <!-- Drug Toxicology Results using Results template -->
 +
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
 +
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
 +
                          <code xsi:type="CE" code="8150-5"
 +
                              displayName="Amphetamines [Mass/volume] in Urine"
 +
                              codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code>
 +
                          <text>
 +
                              <reference value="#result1"/>
 +
                          </text>
 +
                          <statusCode code="completed"/>
 +
                          <value xsi:type="PQ" value="23" unit="ug/L"/>
 +
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
 +
                          <methodCode/>
 +
                          <targetSiteCode/>
 +
                          <author>
 +
                              <time value="201603190830-0800"/>
 +
                              <assignedAuthor>
 +
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
 +
                              </assignedAuthor>
 +
                          </author>
 +
                          <referenceRange>
 +
                              <observationRange>
 +
                                <text>Low</text>
 +
                                <value xsi:type="IVL_PQ">
 +
                                    <low value="0" unit="ug/L"/>
 +
                                    <high value="10" unit="ug/L"/>
 +
                                </value>
 +
                              </observationRange>
 +
                          </referenceRange>
 +
                        </observation>
 +
                    </component>
 +
                    <component>
 +
                        <observation classCode="OBS" moodCode="EVN">
 +
                          <!-- Drug Toxicology Results using Results template -->
 +
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
 +
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
 +
                          <code xsi:type="CE" code="3394-4^"
 +
                              displayName="Benzoylecgonine [Mass/volume] in Urine"
 +
                              codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code>
 +
                          <text>
 +
                              <reference value="#result2"/>
 +
                          </text>
 +
                          <statusCode code="completed"/>
 +
                          <value xsi:type="PQ" value="0.3" unit="mg/L"/>
 +
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
 +
                          <methodCode/>
 +
                          <targetSiteCode/>
 +
                          <author>
 +
                              <time value="201603190830-0800"/>
 +
                              <assignedAuthor>
 +
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
 +
                              </assignedAuthor>
 +
                          </author>
 +
                          <referenceRange>
 +
                              <observationRange>
 +
                                <text>Low</text>
 +
                                <value xsi:type="IVL_PQ">
 +
                                    <low value="0" unit="mg/L"/>
 +
                                    <high value="0.1" unit="mg/L"/>
 +
                                </value>
 +
                              </observationRange>
 +
                          </referenceRange>
 +
                        </observation>
 +
                    </component>
 +
                    <component>
 +
                        <observation classCode="OBS" moodCode="EVN">
 +
                          <!-- Drug Toxicology Results using Results template -->
 +
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
 +
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
 +
                          <code xsi:type="CE" code="42860-7"
 +
                              displayName="Cannabinoids [Mass/volume] in Urine"
 +
                              codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code>
 +
                          <text>
 +
                              <reference value="#result3"/>
 +
                          </text>
 +
                          <statusCode code="completed"/>
 +
                          <value xsi:type="PQ" value="10" unit="ug/L"/>
 +
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
 +
                          <methodCode/>
 +
                          <targetSiteCode/>
 +
                          <author>
 +
                              <time value="201603190830-0800"/>
 +
                              <assignedAuthor>
 +
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
 +
                              </assignedAuthor>
 +
                          </author>
 +
                          <referenceRange>
 +
                              <observationRange>
 +
                                <text>Low</text>
 +
                                <value xsi:type="IVL_PQ">
 +
                                    <low value="0" unit="ug/L"/>
 +
                                    <high value="10" unit="ug/L"/>
 +
                                </value>
 +
                              </observationRange>
 +
                          </referenceRange>
 +
                        </observation>
 +
                    </component>
 +
                    <component>
 +
                        <observation classCode="OBS" moodCode="EVN">
 +
                          <!-- Drug Toxicology Results using Results template -->
 +
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
 +
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
 +
                          <code xsi:type="CE" code="8220-6"
 +
                              displayName="Opiates [Mass/volume] in Urine"
 +
                              codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC">                             
 +
                          </code>
 +
                          <text>
 +
                              <reference value="#result4"/>
 +
                          </text>
 +
                          <statusCode code="completed"/>
 +
                          <value xsi:type="PQ" value="0" unit="ug/L"/>
 +
                          <methodCode/>
 +
                          <targetSiteCode/>
 +
                          <author>
 +
                              <time value="201603190830-0800"/>
 +
                              <assignedAuthor>
 +
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
 +
                              </assignedAuthor>
 +
                          </author>
 +
                          <referenceRange>
 +
                              <observationRange>
 +
                                <text>Low</text>
 +
                                <value xsi:type="IVL_PQ">
 +
                                    <low value="0" unit="ng/L"/>
 +
                                    <high value="10" unit="ng/L"/>
 +
                                </value>
 +
                              </observationRange>
 +
                          </referenceRange>
 +
                        </observation>
 +
                    </component>
 +
                    <component>
 +
                        <observation classCode="OBS" moodCode="EVN">
 +
                          <!-- Drug Toxicology Results using Results template -->
 +
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
 +
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
 +
                          <code xsi:type="CE" code="3937-0"
 +
                              displayName="Phencyclidine [Mass/volume] in Urine"
 +
                              codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"> </code>
 +
                          <text>
 +
                              <reference value="#result5"/>
 +
                          </text>
 +
                          <statusCode code="completed"/>
 +
                          <value xsi:type="PQ" value="23" unit="mg/L"/>
 +
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
 +
                          <methodCode/>
 +
                          <targetSiteCode/>
 +
                          <author>
 +
                              <time value="201603190830-0800"/>
 +
                              <assignedAuthor>
 +
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
 +
                              </assignedAuthor>
 +
                          </author>
 +
                          <referenceRange>
 +
                              <observationRange>
 +
                                <text>Low</text>
 +
                                <value xsi:type="IVL_PQ">
 +
                                    <low value="0" unit="mg/L"/>
 +
                                    <high value="10" unit="um/L"/>
 +
                                </value>
 +
                              </observationRange>
 +
                          </referenceRange>
 +
                        </observation>
 +
                    </component>
 +
                  </organizer>
 +
              </entry>
 +
=== Provide Real-time Query for Observations===
 +
The BH EHR supports the "Observation"  and "Patient" resources to support real-time queries from authorized applications (e.g. consumer-facing, quality reporting, state reporting, etc.).
 +
*The client application may search by patient and/or by Observation (panel - 24349-3 for "Drugs of abuse 5 panel - Urine") code depending on it purpose
 +
*The BH EHR would return the matching panels or individual tests
  
 +
<font color="blue">
 +
<Observation xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://hl7.org/fhir">
 +
  <id value="121"/>
 +
  <text>...</text>
 +
  <identifier>
 +
    <use value="official"/>
 +
    <system value="urn:observations"/>
 +
    <value value="6324"/>
 +
  </identifier>
 +
  <status value="final"/>
 +
  <code>
 +
    <coding>
 +
      <system value="http://loinc.org"/>
 +
      <code value="'''24349-3'''"/>
 +
      <display value="'''Drugs of abuse 5 panel - Urine'''"/>
 +
    </coding>
 +
  </code>
 +
  <subject>
 +
    <reference value="Patient/1234"/>
 +
    <display value="Sally Share"/>
 +
  </subject>
 +
  <effectivePeriod>
 +
    <start value="2016-04-02T10:30:10+01:00"/>
 +
    <end value="2016-04-05T10:30:10+01:00"/>
 +
  </effectivePeriod>
 +
  <issued value="2016-04-03T15:30:10+01:00"/>
 +
  <performer>
 +
    <reference value="Practitioner/2343242"/>
 +
    <display value="John Lister"/>
 +
  </performer>
 +
  <component>
 +
    <code>
 +
      <coding>
 +
        <system value="http://loinc.org"/>
 +
        <code value="'''8150-'''5"/>
 +
        <display value="'''Amphetamines [Mass/volume] in Urine'''"/>
 +
      </coding>
 +
    </code>
 +
    <valueQuantity>
 +
      <value value="23"/>
 +
      <unit value="ug/L"/>
 +
      <system value="http://unitsofmeasure.org"/>
 +
      <code value="ug/L"/>
 +
    </valueQuantity>
 +
    <referenceRange>
 +
      <low>
 +
        <value value="0"/>
 +
        <unit value="ug/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="ug/L"/>
 +
      </low>
 +
      <high>
 +
        <value value="10"/>
 +
        <unit value="ug/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="ug/L"/>
 +
      </high>
 +
    </referenceRange>
 +
  </component>
 +
  <component>
 +
    <code>
 +
      <coding>
 +
        <system value="http://loinc.org"/>
 +
        <code value="'''3394-4'''"/>
 +
        <display value="'''Benzoylecgonine [Mass/​volume] in Urine'''"/>
 +
      </coding>
 +
    </code>
 +
    <valueQuantity>
 +
      <value value="0.3"/>
 +
      <unit value="mg/L"/>
 +
      <system value="http://unitsofmeasure.org"/>
 +
      <code value="mg/L"/>
 +
    </valueQuantity>
 +
    <referenceRange>
 +
      <low>
 +
        <value value="0"/>
 +
        <unit value="mg/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="mg/L"/>
 +
      </low>
 +
      <high>
 +
        <value value="0.1"/>
 +
        <unit value="mg/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="mg/L"/>
 +
      </high>
 +
    </referenceRange>
 +
  </component>
 +
  <component>
 +
    <code>
 +
      <coding>
 +
        <system value="http://loinc.org"/>
 +
        <code value="'''42860-7'''"/>
 +
        <display value="'''Cannabinoids [Mass/​volume] in Urine'''"/>
 +
      </coding>
 +
    </code>
 +
    <valueQuantity>
 +
      <value value="15"/>
 +
      <unit value="ug/L"/>
 +
      <system value="http://unitsofmeasure.org"/>
 +
      <code value="ug/L"/>
 +
    </valueQuantity>
 +
    <referenceRange>
 +
      <low>
 +
        <value value="0"/>
 +
        <unit value="ug/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="ug/L"/>
 +
      </low>
 +
      <high>
 +
        <value value="10"/>
 +
        <unit value="ug/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="ug/L"/>
 +
      </high>
 +
    </referenceRange>
 +
  </component>
 +
  <component>
 +
    <code>
 +
      <coding>
 +
        <system value="http://loinc.org"/>
 +
        <code value="'''3937-0'''"/>
 +
        <display value="'''Phencyclidine [Mass/volume] in Urine'''"/>
 +
      </coding>
 +
    </code>
 +
    <valueQuantity>
 +
      <value value="23"/>
 +
      <unit value="ug/L"/>
 +
      <system value="http://unitsofmeasure.org"/>
 +
      <code value="ug/L"/>
 +
    </valueQuantity>
 +
    <referenceRange>
 +
      <low>
 +
        <value value="0"/>
 +
        <unit value="ug/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="ug/L"/>
 +
      </low>
 +
      <high>
 +
        <value value="10"/>
 +
        <unit value="ug/L"/>
 +
        <system value="http://unitsofmeasure.org"/>
 +
        <code value="ug/L"/>
 +
      </high>
 +
    </referenceRange>
 +
  </component>
 +
</Observation>
 +
</font>
  
 
[[Category:Work_Group]]
 
[[Category:Work_Group]]
 
[[Category:Domain_Experts_Steering_Division]]
 
[[Category:Domain_Experts_Steering_Division]]
 
[[Category:CBCC]]
 
[[Category:CBCC]]

Latest revision as of 17:28, 4 August 2016

Cross-Paradigm Behavioral Health (BH) Data Exchange Project

Drug Toxicology Scenario

The following is an example scenario intended to illustrate how implementers will use HL7 V2.5.1 for lab orders and result reporting, C-CDA documents, and FHIR resource to convey drug toxicology information for a patient receiving treatment for PTSD (ICD-10 F43.10).

  • 24349-3 Drugs of abuse 5 panel - Urine
    • 8150-5: Amphetamines [Mass/volume] in Urine (ug/L)
    • 3394-4: Benzoylecgonine [Mass/volume] in Urine (mg/L)
    • 42860-7: Cannabinoids [Mass/volume] in Urine (ug/L)
    • 8220-6: Opiates [Mass/volume] in Urine (ng/L)
    • 3937-0: Phencyclidine [Mass/volume] in Urine (ug/L)


Drug Toxicology Ordering

A BH EHR sends a Drug Toxicology Order (as an LOI-conformant V2.5.1 message):

  • The patient, Sally Share, is treated for PTSD and her provider suspects that she may be suffering a substance use disorder
  • The provider order a toxicology panel (24349-3^Drugs of abuse 5 panel - Urine) for Sally Share from a local laboratory
  • The provider collects the specimen (urine) and sends to the laboratory - a reference to the specimen is included in the order

MSH|^~\&|BH-EHR^2.16.840.1.113883.3.72.5.22^ISO|EHR Facility^2.16.840.1.113883.3.72.5.23^ISO|Reference Laboratory^2.16.840.1.113883.3.72.5.20^ISO|Lab Facility^2.16.840.1.113883.3.72.5.21^ISO|20160211184101-0500||OML^O21^OML_O21|NIST-LOI_8.0_1.1-GU|T|2.5.1|||AL|NE|||||LOI_Common_Component^LOI Base Profile^2.16.840.1.113883.9.66^ISO~LOI_GU_Component^LOI GU Profile^2.16.840.1.113883.9.78^ISO~LAB_PRU_Component^LOI PRU Profile^2.16.840.1.113883.9.82^ISO

PID|1||PATID1234^^^&2.16.840.1.113883.3.72.5.30.2&ISO^MR||Share^Sally^A^^^^L||19281011|F||2106-3^White^HL70005|1500 Patient Way^Apt 4^Huntington Park^CA^90255^^H|||||||||||H^Hispanic^HL70189

ORC|NW|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||ORD798642^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO|||||20160124||57422^Hippocrates^Harold|57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^^PH^^^626^9876543^1||||||2^Patient has been informed of responsibility, and agrees to pay for service^HL70339

OBR|1|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||24349-3^Drugs of abuse 5 panel - Urine^LN|||201603190830-0800|||||||||57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^^PH^^^626^9876543^1

DG1|1||F43.10^Posttraumatic Stress Disorder^I10C|||F|||||||||3

SPM|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||122575003^UrineSpecimen^SCT|||||||||||||201603190830-0800


Drug Toxicology Results Reporting

The laboratory receives the specimen from the BH provider and performs the tests specified in the panel definition (http://s.details.loinc.org/LOINC/24349-3.html?sections=Simple). The lab transmits the Lab Results message (LRI conformance V2.5.1 message) to the BH EHR to be reviewed and interpreted by the provider. The example results transactions are using 42860-7^Cannabinoids [Mass/​volume] in Urine rather than 52954-5^Cannabinoids [Moles/volume] in Urine to analyze the level of Cannabinoids in urine.

MSH|^~\&|Reference Laboratory^2.16.840.1.113883.3.72.5.20^ISO|Lab Facility^2.16.840.1.113883.3.72.5.21^ISO|BH-EHR^2.16.840.1.113883.3.72.5.22^ISO|EHR Facility^2.16.840.1.113883.3.72.5.23^ISO|20160601140551-0500||ORU^R01^ORU_R01|NIST-LRI-GU-002.00|T|2.5.1|||AL|NE|||||LRI_Common_Component^^2.16.840.1.113883.9.16^ISO~LRI_GU_Component^^2.16.840.1.113883.9.12^ISO~LRI_RU_Component^^2.16.840.1.113883.9.14^ISO

PID|1||PATID1234^^^&2.16.840.1.113883.3.72.5.30.2&ISO^MR||Share^Sally^A^^^^L||19281011|F||2106-3^White^HL70005|1500 Patient Way^Apt 4^Huntington Park^CA^90255^^H|||||||||||H^Hispanic^HL70189

ORC|RE|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||ORD798642^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO|||||20160124||57422^Hippocrates^Harold|57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^^PH^^^626^9876543^1||||||2^Patient has been informed of responsibility, and agrees to pay for service^HL70339

OBR|1|ORD798642-3^BH-EHR^2.16.840.1.113883.3.72.7.83^ISO||24349-3^Drugs of abuse 5 panel - Urine^LN|||201603190830-0800|||||||||57422^Hippocrates^Harold^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^^PH^^^626^9876543^1

OBX|1|NM|8150-5^Amphetamines [Mass/volume] in Urine^LN||23|ug/L^micrograms per liter^UCUM|0 to 10|H|||F|||20160103143428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|2|NM|3394-4^Benzoylecgonine [Mass/​volume] in Urine^LN||0.3|mg/L^milligrams per liter^UCUM|0 to 0.1|H|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|3|NM|42860-7^Cannabinoids [Mass/​volume] in Urine^LN||15|ug/L^micrograms per liter^UCUM|0 to 10|H|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|4|NM|8220-6^Opiates [Mass/​volume] in Urine^LN||0|ng/L^nanograms per liter^UCUM|0 to 10|N|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

OBX|5|NM|3937-0^Phencyclidine [Mass/​volume] in Urine^LN||23|ug/L^micrograms per liter^UCUM|0 to 10|H|||F|||20160601133428-0800|||||20160103163428-0800||||Century Hospital^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|2070 Test Park^^Los Angeles^CA^90067^^B|2343242^Lister^John^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^DN

SPM|1|SP798642-2&BH-EHR&2.16.840.1.113883.3.72.7.83&ISO||122575003^Urine Specimen^SCT|||||||||||||201603190830-0800

Send Drug Toxicology Results in a Referral Document to Substance Abuse Treatment Provider

The mental health provider using the BH EHR refers Shally Share to a substance abuse treatment provider in her community and includes the most recent drug toxicology along with other notes.

  • The results are sent in a C-CDA 2.1 "Results" section using "Results Organizer" for the panel and "Result" template for each rest in the panel.
               <entry typeCode="DRIV">
                 <organizer classCode="BATTERY" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.1" extension="2015-08-01"/>
                    <id root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
                    
                    <statusCode code="completed"/>
                    <effectiveTime>
                       <low value="201603190830-0800"/>
                       <high value="201603190830-0800"/>
                    </effectiveTime>
                    <author>
                       
                       <assignedAuthor>
                          <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                          <telecom use="WP" value="tel:555-555-1002"/>
                          <assignedPerson>
                             <name>
                                <given>John</given>
                                <family>Lister</family>
                             </name>
                          </assignedPerson>
                          <representedOrganization>
                             <name>Century Hospital</name>
                          </representedOrganization>
                       </assignedAuthor>
                    </author>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result1"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="23" unit="ug/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="ug/L"/>
                                   <high value="10" unit="ug/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result2"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="0.3" unit="mg/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="mg/L"/>
                                   <high value="0.1" unit="mg/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result3"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="10" unit="ug/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="ug/L"/>
                                   <high value="10" unit="ug/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                                                        
                          
                          <text>
                             <reference value="#result4"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="0" unit="ug/L"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="ng/L"/>
                                   <high value="10" unit="ng/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                    <component>
                       <observation classCode="OBS" moodCode="EVN">
                          <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
                          <id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           
                          <text>
                             <reference value="#result5"/>
                          </text>
                          <statusCode code="completed"/>
                          <value xsi:type="PQ" value="23" unit="mg/L"/>
                          <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83"/>
                          <methodCode/>
                          <targetSiteCode/>
                          <author>
                             
                             <assignedAuthor>
                                <id root="2.16.840.1.113883.3.72.5.22" extension="2343242"/>
                             </assignedAuthor>
                          </author>
                          <referenceRange>
                             <observationRange>
                                <text>Low</text>
                                <value xsi:type="IVL_PQ">
                                   <low value="0" unit="mg/L"/>
                                   <high value="10" unit="um/L"/>
                                </value>
                             </observationRange>
                          </referenceRange>
                       </observation>
                    </component>
                 </organizer>
              </entry>

Provide Real-time Query for Observations

The BH EHR supports the "Observation" and "Patient" resources to support real-time queries from authorized applications (e.g. consumer-facing, quality reporting, state reporting, etc.).

  • The client application may search by patient and/or by Observation (panel - 24349-3 for "Drugs of abuse 5 panel - Urine") code depending on it purpose
  • The BH EHR would return the matching panels or individual tests

<Observation xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://hl7.org/fhir">
 <id value="121"/>
 <text>...</text>
 <identifier>
   <use value="official"/>
   <system value="urn:observations"/>
   <value value="6324"/>
 </identifier>
 <status value="final"/>
 
   <coding>
     <system value="http://loinc.org"/>
     
     <display value="Drugs of abuse 5 panel - Urine"/>
   </coding>
 
 <subject>
   <reference value="Patient/1234"/>
   <display value="Sally Share"/>
 </subject>
 <effectivePeriod>
   <start value="2016-04-02T10:30:10+01:00"/>
   <end value="2016-04-05T10:30:10+01:00"/>
 </effectivePeriod>
 <issued value="2016-04-03T15:30:10+01:00"/>
 <performer>
   <reference value="Practitioner/2343242"/>
   <display value="John Lister"/>
 </performer>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Amphetamines [Mass/volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="23"/>
     <unit value="ug/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="10"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Benzoylecgonine [Mass/​volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="0.3"/>
     <unit value="mg/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="mg/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="0.1"/>
       <unit value="mg/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Cannabinoids [Mass/​volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="15"/>
     <unit value="ug/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="10"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
 <component>
   
     <coding>
       <system value="http://loinc.org"/>
       
       <display value="Phencyclidine [Mass/volume] in Urine"/>
     </coding>
   
   <valueQuantity>
     <value value="23"/>
     <unit value="ug/L"/>
     <system value="http://unitsofmeasure.org"/>
     
   </valueQuantity>
   <referenceRange>
     <low>
       <value value="0"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </low>
     <high>
       <value value="10"/>
       <unit value="ug/L"/>
       <system value="http://unitsofmeasure.org"/>
       
     </high>
   </referenceRange>
 </component>
</Observation>