Laboratory IT Initiatives in Saskatchewan HL7 Regina Conference - June 7, 2001

Laboratory IT Initiatives in Laboratory IT Initiatives in SaskatchewanSaskatchewan

HL7 Regina Conference - June 7, 2001HL7 Regina Conference - June 7, 2001• Presentation Purpose is to discuss use of HL7 V3, not the Lab

Standard itself• Vision for Electronic Test Requisition and Result Reporting

– Provincial, not in-hospital/lab– presentation emphasis on CONTENT, not FORMAT– CONTENT:

• HL7 V3 Reference Information Model• Use of Registries for content quality control

• Strategy & Schedule– Leverage from British Columbia’s work on LOINC & HL7

• Saskatchewan is reviewing the BC Standard and identifying areas of “difference” for resolution

• Areas of difference include use of registries and associated governance models (e.g. assignment of new LOINC codes)

– Partnership through the Western Health Information Collaborative (WHIC) & CIHI

Telemedicine

Health “region”Health “region”

PharmacyPharmacy

Community PharmacyFeeder Systems

PharmacyPharmacy

MPI/ADTMPI/ADT

LabLab OCOC

ERER

RadiologyRadiology

HospitalFeeder Systems

Immunization Immunization

LTCLTC

LaboratoryLaboratory

Speech PathSpeech Path

Home CareHome Care

Community ClinicFeeder Systems

Lab Feeder Systems

LTC Facility Feeder Systems

Regional Clinical

Data Repository

Tele-HomecareTele-HomecareHealth “region”Health “region”

Tele-Homecare

Interfaces

Access Protocols

Metadata

DirectoryDirectory

Env HealthEnv Health

Access

Regional Clinical

Data Repository

Laboratory Specific Data Laboratory Specific Data & Messaging Standards& Messaging Standards

Registries to Support Registries to Support Identifiers for Clients, Identifiers for Clients,

Providers, Lab Providers, Lab Facilities/Organizations Facilities/Organizations and Lab Test Identifiers and Lab Test Identifiers

& Nomenclatures& Nomenclatures

Laboratory IT Initiatives in SaskatchewanLaboratory IT Initiatives in Saskatchewan

VISIONVISION

Provincial LaboratoryProvincial Laboratory

Provincial Laboratory - Reference & Public Health

Lab Feeder Systems

Clinic ManagementClinic Management

Physician ClinicFeeder Systems

0..*

1 0..*

1EntityEntity ParticipationParticipation ActAct

RoleRoleRelationshipRelationship

0..* 0..*

1 1

ActActRelationshipRelationship

1 1

0..* 0..*

ReferralTransportationSupplyProcedureCondition NodeConsentObservationMedicationAct complexFinancial act

OrganizationLiving SubjectMaterialPlaceHealth Chart

Employee-employerPatient-providerPractitioner-providerPractitioner-certifier

GuarantorHealthcare providerInsurerMilitary personNotary public

RoleRole1

0..*

HL7 RIM Core Classes

Provider RegistryProvider Registry

(WHIC)(WHIC)

Service Recipient RegistryService Recipient Registry

(CIHI)(CIHI)Laboratory Registry Management SystemLaboratory Registry Management System

Test Compendium & Test Compendium & Result NomenclatureResult Nomenclature

RegistriesRegistries


Use of REGISTRIES for Data ContentUse of REGISTRIES for Data ContentOverall Business Process Model: Registry Management InfrastructureOverall Business Process Model: Registry Management Infrastructure

Service Recipient Registry•contains index of all identifiers used by all Sask stakeholders for all patients•Planning for development being led by CIHI and involves provinces, territories and Health Canada “jurisdictions•will require HL7 messages to be balloted

•will require an “owner” not yet identified

Service Provider Registry•contains index of all identifiers used by all Sask stakeholders for all Providers (individuals)•Planning for development being led by WHIC•will require HL7 messages to be balloted•will require an owner not yet identified

(Laboratory) Facility Registry•contains contact data for all Medical Laboratories in Saskatchewan•Planning for development internal to Saskatchewan? or WHIC?•a web-based Registry Management System associated with Laboratory Licensing•will require an “owner”, likely Lab Licensing/Quality Assurance

Strong

Link

Test Compendium Registry contains data for all Medical Tests done by all Labs in Saskatchewan•contains an index for all nomenclatures used by all Labs in Sask for Orders and Tests as well as LOINC codes for these tests•a web-based Registry Management System associated with Laboratory Licensing - a possible WHIC collaboration?•will require an “owner”, likely Lab Licensing/Quality Assurance


TACTICAL PLANS & STATUSTACTICAL PLANS & STATUSProject Deliverables - Design Phase: Project Deliverables - Design Phase:

Overall Business Data Model: Registry Management Overall Business Data Model: Registry Management InfrastructureInfrastructure

Service Recipient Registry

There a 19 publicly funded jurisdictions that issue health cards with unique identifiers in Canada. There are an unknown number of internal (shadow) identifiers assigned by health delivery organizations, and an unknown number of identifiers issued by private 3rd party payors. One person may have several current identifiers presented during one or more care episodes.

Stakeholder Organization

(e.g. Health Registration, SDH,....)

•Sask Unique Id

•Organization Name

•Contact Data

Recipient Person

WHIC(?) Unique Id

•Person Name

•Person Data

Recipient Person/Organization Xref

•WHIC Unique (Person) Id

•WHIC Unique (Organization) Id

•Person/Organization Id



Overall Data Model: Registry Management Overall Data Model: Registry Management InfrastructureInfrastructure

Service Provider Registry

Coming in the fall of 2002. Stakeholder Organization

(e.g. ProvLab, SDH, Regenstrief, SNOMED....)

•Sask Unique Id


•Contact Data

Provider Roles

(e.g. Physician, Pharmacist, Nurse, Dentist, Lab Tech....)

•WHIC Unique Id

•Role Name

•Role DataProvider Person

•WHIC Unique Id

•Person Name

•Person Data

Provider/Role/Organization Xref

•WHIC Unique (Person) Id

•WHIC Unique (Role) Id

•Sask Unique (Orgaization) Id

•(local) Provider Id

•(local) Provider Data




(Laboratory) Facility Registry


(e.g. ProvLab, SDH, RHD, PAHD,....)

•Sask Unique Id


•Contact Data

Laboratory Facility

(e.g. ProvLab, SDH Laboratory....)

•Sask Unique (Organization) Id

•Sask Unique Facility Id

•Facility Name

•Contact Data

Laboratory Facility QA/Licensing Events

•Sask Unique Id

•Event Id

•Event Data


Registry DesignRegistry DesignProject Deliverables - Design Phase: Project Deliverables - Design Phase:


(Laboratory) Facility Registry


(e.g. ProvLab, SDH, RHD, PAHD,....)

•Sask Unique Id


•Contact Data

Laboratory Facility

(e.g. ProvLab, SDH Laboratory....)


•Sask Unique Facility Id

•Facility Name

•Contact Data

Laboratory Facility QA/Licensing Events

•Sask Unique Id

•Event Id

•Event Data

About 200 Labs in Saskatchewan About 200 Labs in Saskatchewan are publicly owned and regulated are publicly owned and regulated

by the Saskatchewan College of by the Saskatchewan College of Physicians & Surgeons and are Physicians & Surgeons and are

licensed by Saskatchewan Health. licensed by Saskatchewan Health. There are almost 230 Physician There are almost 230 Physician

Office Labs in Saskatchewan. Office Labs in Saskatchewan. Saskatchewan needs to build a Saskatchewan needs to build a Registry Management System Registry Management System

according to the guidelines of the according to the guidelines of the HL7V3 RIM. This may be a HL7V3 RIM. This may be a feeder system to the feeder system to the WHIC WHIC

Provider (Organization) Registry. Provider (Organization) Registry. It must, however, be closely tied It must, however, be closely tied

to the Test Compendium Registry to the Test Compendium Registry for licensing and information for licensing and information

management purposes.management purposes.

About 200 Labs in Saskatchewan About 200 Labs in Saskatchewan are publicly owned and regulated are publicly owned and regulated

by the Saskatchewan College of by the Saskatchewan College of Physicians & Surgeons and are Physicians & Surgeons and are

licensed by Saskatchewan Health. licensed by Saskatchewan Health. There are almost 230 Physician There are almost 230 Physician

Office Labs in Saskatchewan. Office Labs in Saskatchewan. Saskatchewan needs to build a Saskatchewan needs to build a Registry Management System Registry Management System

according to the guidelines of the according to the guidelines of the HL7V3 RIM. This may be a HL7V3 RIM. This may be a feeder system to the feeder system to the WHIC WHIC

Provider (Organization) Registry. Provider (Organization) Registry. It must, however, be closely tied It must, however, be closely tied

to the Test Compendium Registry to the Test Compendium Registry for licensing and information for licensing and information

management purposes.management purposes.




Provincial Test

•Sask Unique Id

•Order Name

•Business Rules

Test Xref by Organization

•Sask Unique (Test) Id

•Sask Unique (Org) Id

•Test Name

•Test Code

•Business Rules

Saskatchewan Lab Nomenclatures

•Sask Unique Id

•Organism, Outcome Name

Nomenclature Xref by Organization

•Sask Unique (Nom) Id


•Name



•Sask Unique Id


•Contact Data

Test Compendium RegistryTest Result Nomenclature Registry




Provincial Test

•Sask Unique Id

•Order Name

•Business Rules

Test Xref by Organization

•Sask Unique (Test) Id

•Sask Unique (Org) Id

•Test Name

•Test Code

•Business Rules

Test Compendium Registry

Several grouping levels of this Several grouping levels of this data are required:data are required:

1. Laboratory Licence Test 1. Laboratory Licence Test GroupGroup

2. A Test Panel/Battery (for 2. A Test Panel/Battery (for both Orders & Instruments)both Orders & Instruments)

3. A Named Test3. A Named Test

4. A specific Test/Result 4. A specific Test/Result (LOINC)(LOINC)

HL7 refers to “Act Relationship”:

“A relationship between two acts. This includes numerous relationships, such as “part-of” relationships, which allow both temporal and non-temporal groupings of instances of acts. Examples include batteries of tests or longitudinal guidelines”

Several grouping levels of this Several grouping levels of this data are required:data are required:

1. Laboratory Licence Test 1. Laboratory Licence Test GroupGroup

2. A Test Panel/Battery (for 2. A Test Panel/Battery (for both Orders & Instruments)both Orders & Instruments)

3. A Named Test3. A Named Test

4. A specific Test/Result 4. A specific Test/Result (LOINC)(LOINC)

HL7 refers to “Act Relationship”:

“A relationship between two acts. This includes numerous relationships, such as “part-of” relationships, which allow both temporal and non-temporal groupings of instances of acts. Examples include batteries of tests or longitudinal guidelines”



•Sask Unique Id


•Contact Data




Nomenclature Xref by Organization

•Sask Unique (Nom) Id


•Name



•Sask Unique Id


•Contact Data

Test Result Nomenclature Registry

Saskatchewan Lab Nomenclatures

•Sask Unique Id

•Organism, Outcome Name

These Nomenclatures are These Nomenclatures are also being addressed for also being addressed for Public Health Public Health Surveillance. The Surveillance. The proposed data structure proposed data structure would allow any required would allow any required cross-reference between cross-reference between local, provincial and local, provincial and national identifiers.national identifiers.

These Nomenclatures are These Nomenclatures are also being addressed for also being addressed for Public Health Public Health Surveillance. The Surveillance. The proposed data structure proposed data structure would allow any required would allow any required cross-reference between cross-reference between local, provincial and local, provincial and national identifiers.national identifiers.


Action Plan Schedule for Registry Action Plan Schedule for Registry Development & ImplementationDevelopment & Implementation

Provider Registry (WHIC)

Service Recipient Registry (CIHI)

Laboratory Registry Management System

Test Compendium & Result Nomenclature Registries

Populate the Lab/Test Compendium & Result Registries

Lab Data Standards Business Design

WHIC WHIC Collaboration?Collaboration?


Use of REGISTRIES for Data ContentUse of REGISTRIES for Data ContentProject Deliverables - Design Phase: Project Deliverables - Design Phase:

Overall Business Process Model: Ordering and Result ReportingOverall Business Process Model: Ordering and Result Reporting

Other JurisdictionRegistriesOther JurisdictionRegistries

Lab Web Lab Web PortalPortal

Enter Enter Order Order /Retrieve /Retrieve ResultsResults

(Physician, (Physician, Lab)Lab)


Prepare & Prepare & Mail Mail

SpecimenSpecimen

(Lab, Clinic)(Lab, Clinic)


Receive Receive Sample Sample

/Retrieve /Retrieve Order /Do Order /Do

Test /Record Test /Record ResultsResults

(Laboratory)(Laboratory)Prepare & Mail Prepare & Mail

SpecimenSpecimen

(Lab, Clinic)(Lab, Clinic)

Enter Enter Order Order /Retrieve /Retrieve ResultsResults

(Physician, (Physician, Lab)Lab)

HL7HL7

Saskatchewan RegistriesSaskatchewan Registries

HL7HL7


Scenarios of Possible Laboratory Scenarios of Possible Laboratory Transactions – manual systems Transactions – manual systems using Web portalusing Web portal

Dr. Smith orders CBC on John Doe via Web portal – info verified by Web application using registries.

John Doe goes to LittleTown Lab – at Lab reception, info retrieved by Web application and collection recorded - sample numbered.

Sample taken to LittleTown Lab bench – info retrieved by Web application, sample processed and result recorded by Web application. Added info verified using registries.

Dr. Smith looks for John Doe result on Web and finds it.

Dr. Smith sends John Doe to Dr. Jones, a specialist. Dr. Jones looks on the Web portal for past lab test results for John Doe and finds the CDC result.


Scenarios of Possible Laboratory Scenarios of Possible Laboratory Transactions – computer systems Transactions – computer systems using messagingusing messaging

Dr. Brown orders cholesterol on Mary Doe from his practice management system – info verified by messaging to registries.

Mary Doe goes to Somewhere Bleeding Station –info retrieved and collection recorded by messaging - sample numbered.

Sample arrives at BigLab – info retrieved by LIS application through messaging, sample processed and result sent through messaging. Added info verified using registries.

Dr. Brown looks for Mary Doe result on his PMS and finds it along with a cholesterol fractionation done because cholesterol was high.


Scenarios of Possible Laboratory Scenarios of Possible Laboratory Transactions - mixedTransactions - mixedDoctor uses the Web, but the Collection Point/Lab uses a computer system with messaging.

Lab test was done rurally using Web applications but is being found by another physician because the patient became sick when visiting town. The city physician has a practice management system.

Assumes the order and results exist in a central database or directory share by Web apps and HL7 messaging.


Scenarios of Possible Laboratory Scenarios of Possible Laboratory Transactions – validation earlyTransactions – validation early

Dr. White attempts to place an order and finds that the patient does not exist in the registry with the ID given to the doctor. He finds a ‘Richard Robin’, address in townA, in the registry, while he knows his patient as ‘Dick Robin’, address in townB. The patient confirms that he is the same person. Doctor changes his system to ‘Richard’ and the registry to the address in townB.

When patient arrives to have sample collected there is no problem with name or birth date.

Lab calls organism ‘E.coli’. System consults registry for agreed name ‘Escherichia coli’. Referral lab goes to registry to retrieve its name ‘E COLI’ before further lab work on the organism.

Assumes that all messages are validated before sending using the registries.


Scenarios of Possible Laboratory Scenarios of Possible Laboratory Transactions - helpTransactions - help

Dr. Farout wants to order a very unusual test. His system does not list it, but he finds and orders it via the Web site rather than his PMS.

The patient goes to a collection center and they do not have the test on their system either. They use the Web site to find what has to be collected and where it must be sent.

The lab does not do this test without prior agreement with the physician on the merit of the circumstances. They decide to substitute another test and do the ordered test only if the substitute has an abnormal result. The lab cancels the ordered test and result (as normal) the substitute test with a comment.

The physician uses the comment info to access a paper on this group of tests and their interpretation on the Web portal.


Scenarios of Possible Laboratory Scenarios of Possible Laboratory Transactions – Completely LocalTransactions – Completely LocalAn intern orders a test on a patient in hospital directly into the hospitals LIS. Collection and reporting are also entirely within the LIS. The whole transaction can be reported to a central directory or database with a series of HL7 messages after the fact. The LIS will have to have the standards to make valid messages ‘after the fact’.

Alternatively, the hospital may use messaging to communicate between separate ward, collection and lab systems. A lab might even have a number of separate specialized lab systems rather than a single LIS and use messaging for input and output.


Scenarios of Possible Laboratory Scenarios of Possible Laboratory Transactions – Incomplete testingTransactions – Incomplete testing

Dr. Black instructs a patient to go to a local hospital for a lab test and orders the test on the Web.

The patient decides he feels better and will not go for the test.

At some point, the central system can notify Dr. Black that his patient did not have the test done and cancel the order.

Or…

Before this, the patient may feel bad again and go to Dr. Green. The physician orders the same test and gets a message that there is an order with collection pending. There are many ways to resolve this situation depending on the physicians.


Action Plan Schedule for Action Plan Schedule for Laboratory Message and Data Laboratory Message and Data Standard Development & Standard Development & ImplementationImplementation


WHIC Lab Data Standards HL7 Message Specification

CIHI Lab Data Standards HL7 Message Specification

Lab Data Standards HL7 Message Balloting

WHICWHIC CIHICIHI

CIHI Lab Data Standards HL7 Message Specification


3rd Party Laboratory, Hospital & 3rd Party Laboratory, Hospital & Practice Management System ImpactsPractice Management System Impacts


WHIC Lab Data Standards HL7 Message Specification

Lab Data Standards HL7 Message Balloting

HL7 Compliance with:

Laboratory Test Order & Results & Associated Messages

Service Recipient Look-up, Add & Change Messages

Service Provider Look-up, Add & Change Messages

Test Compendium Look-up Messages, (Add & Change?)

Result Nomenclature Look-up Messages, (Add & Change?)

Network Security Compliance

Laboratory IT Initiatives in Saskatchewan HL7 Regina Conference - June 7, 2001

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Transcript of Laboratory IT Initiatives in Saskatchewan HL7 Regina Conference - June 7, 2001