Cross-Paradigm Behavioral Health (BH) Data Exchange Project

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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>

Cross-Paradigm Behavioral Health Exchange Project

Contents

Cross-Paradigm Behavioral Health (BH) Data Exchange Project

Drug Toxicology Scenario

Drug Toxicology Ordering

Drug Toxicology Results Reporting

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

Provide Real-time Query for Observations

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