OO Behavioral Model Conceptual Specification
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- 1 Laboratory Request
- 2 Executive Summary
- 3 Open Issues
- 4 Business Model Conceptual Artifacts
- 5 Information Model Conceptual Artifacts
- 6 Solution Specification
- 6.1 Scenario #1 - Simple Lab Order
- 6.2 Implemented Patterns
- 6.3 Contractual Semantics and Issues
- 6.4 Computational Services
- This document contains the necessary definitions, descriptions, graphics, and artifacts relevant to the implementation of an electronic request for healthcare services between an ordering provider and a performing laboratory. In this document, laboratory refers to the collection and processing of specimens.
- Conceptual Roles: I suggest changing “healthcare information” in the description for the 2 systems to “laboratory information”.
- Conceptual State Model: I think it would be helpful to have a state model in the storyboards or before the comprehensive state model. This would fill in the gaps and help mess the see the derivation of “the following request object states and transitions from the above storyboards”.
- Conceptual State Model: The paragraph after the 1st state model starts “As you can see, the request object”. Frankly, I cannot see how the state model tracks from the storyboards. In addition, you use different terms in the state model such as fulfiller, fulfillment resolution, etc. that aren’t defined or, otherwise, explained.
- In Contract Roles and Agents, you are using different terms for the Commissioning System Role and the Responsible System Role without linking them to the terms in the event flow (Provider Order Management System: Ordering System, Laboratory Point of Service System: Specimen Collector System, & Laboratory: Laboratory Information System). It would help in reading the more system-centric diagrams if this connection was made.
Business Model Conceptual Artifacts
- The laboratory domain comprises the models, messages, and other artifacts that are needed to support messaging related to laboratory tests, or observations.
- The HL7 Laboratory domain includes the provision and use of analytic services in areas such as chemistry, hematology, serology, histology, cytology, anatomic pathology, microbiology, and virology. It does not include blood bank or blood transfusion services. (Note that not all lab specializations will be supported in this first HL7 V3 R1 of the Laboratory Request Topic.)
- Analytic services typically result in observations returned to the order placer and/or added to the patient medical history. Observations may be simple numeric quantitative measurements, such as a blood serum glucose level, qualitative measurements such as micro-organism susceptibility to a particular antibiotic, or complex diagnostic pathology reports.
- Services may be delivered/executed at a external lab, an on-site lab, or at the point of care. This topic covers service requests from all locations, including bedside and in-hospital, clinic and outpatient, and lab-to-lab interactions. It includes orders accompanied by specimens to be analyzed, as well as orders for which the performing laboratory is responsible for obtaining the specimens. Observations (results) may be generated for both ordered and unordered (e.g., POC) tests.
- Workflow includes ability of service provider to accept, modify, or reject an order, with appropriate intent indication to the orderer. Modification may include breaking a parent order into child orders or work items Modification include substituting a particular test Available/orderable Laboratory services may be described by an act in definition mood.
For Laboratory Diagnostics (specimen testing), the following illustrates high-level business functions:
Basic business process steps:
- Diagnostic (or Public Health) Specimen-based Laboratory work requested for a subject (patient, animal, environmental location, etc)
- Specimen collected from subject
- Specimen accessioned by lab (i.e., enters lab testing process)
- Specimen processed into testable samples
- Samples tested by lab
- Results from lab testing obtained, interpreted, and approved/authorized
- Results returned to requester
- Requester determines next steps and course of action
While the above list shows the performed steps in a basic lab ordering/fulfillment process, each of these steps may be performed by different actors/roles in any one specific process; for example, a Clinician, Laboratory Technician (e.g., phlebotomist), Investigation Team Member, the Subject (patient), or a person responsible for a Subject may collect the specimen. In addition, the steps may be performed at different locations; specimens may be collected at the point of care, at the subject's location (e.g., at a patient's home, "in the field", etc), in the testing lab, or at a specimen collection organization. The steps may also be performed in different order or not performed at all under given, specific conditions - a specimen may not require any processing prior to being tested or a specimen is assigned an accession number prior to being collected if it is being collected in the lab. Finally, the involvement of an electronic system to capture the information and facilitate the business process is not assumed in the above steps and may not be present depending upon the conditions under which each step is performed.
Storyboards and Activity Diagrams
- Universal Storyboard – Simple Request
- Universal Storyboard – Revise, Hold, Abort Request
- Universal Storyboard - Specimen Problems Request
Information Model Conceptual Artifacts
Conceptual Information Model
Comment: Provide links to the Analysis Information Model for the domain
The following classes were derived from the storyboards and use cases.
Conceptual Data Types Model
Conceptual State Model
We can derive the following request object states and transitions from the above storyboards:
As you can see, the request object has a status for when the fulfiller asserts the request is fulfilled, but the request has not yet evaluated that assertion (called fulfillment resolution). There are also the two other, expected, request statuses: active and complete. In the simplest request use cases, the request only takes one of these states. We can derive the following fulfillment object states and transitions from the storyboard:
Again the status, this time for fulfillment, is restricted in this simplest use case to null and resulted.
Lastly for this simple use case, we can derive the following result object states and transitions from the storyboard:
In this use case, only the completed state is important for interoperability.
Scenario #1 - Simple Lab Order
The event flow for a simple lab order is shown below
Contract Roles and Agents
The commissioning and responsible parties involved in this process include:
|Specification Reference||Commissioning System Role||Responsible System Role||Operation|
|Order Requestor (Placer in v2)||Order Request Manager||createRequest|
|Order Request Manager||Fulfillment Manager||createRequest|
The following sequence diagram depicts the interactions that support the above event flow
Comment: Describe any dependencies of the process being specified
The parties supporting this process are the Order Request Manager and Fulfillment Manager, depicted below
Comment: Indicate the any patterns that apply to this process specification
Contractual Semantics and Issues
Comment: define the conformance criteria for this specification