Electronic laboratory reporting (ELR) - Issues

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Jurisdictional requirements

  • For lab system vendors and labs: States have a variety of reporting formats they require
    • Itemize variations among states

Message structure

  • For states: Labs send message in a variety of formats
    • Itemize variations among submitting labs/vendors
  • For states: Labs submit messages in a variety of erroneous or questionable or suboptimal formats, although they may be syntactically correct
  • New York State (collect samples of all the conditions below)
    • Some labs submit a multiple-observation message as multiple messages with one observation (OBX) per message
    • some labs submit OBX segments containing information that should be in NTE (Note) segments
    • Some labs submit NTE segments with observation information that should be in OBX segments
    • Some labs use OBX-5 repetitions incorrectly, or at least questionably: simply to chop up a long Text result into short pieces
  • Microbiology linkage
    • Most labs don’t do it
      • Some labs even send the drug sensitivity observations in separate messages/files from the organism results: no linkage is possible
    • Of those who do it, none does it completely correctly
    • The 2.5.1 IG is not clear enough about certain requirements
  • The HL7 manual is not crystal clear about when OBX-5 repetitions are appropriate and when they aren’t

Terminology

  • Placeholder

Implementation

  • Discussion between Jimmy Dee and Lily Tatham on PhConnect, ELR CoP forum, and further discussion on the CSI (Collaborative Software Initiative, authors of Utah’s TriSano) forum.
  • Not all labs have CLIA codes, e.g. Veterans Administration hospital labs.
  • Clem McDonald comments during WG webinar
    • “Implementers don’t like to use Structured Numeric.”
    • “No microbiology lab wants to flag abnormals.”

Harmonization

  • How much can we/should we harmonize with IHE profiles?