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Laboratory Pilots/Deployment

Laboratory Pilots/Deployment. September 18, 2012. Participants. Production/Deployment Project P articipants Allscripts (EHR) Athenahealth (EHR) Cerner (EHR/LIS/HIE) OPTUMInsight (HIE/EHR) RML (LIS) LabCorp (LIS) Halfpenny Technologies (Integrator) ARUP (LIS).

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Laboratory Pilots/Deployment

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  1. Laboratory Pilots/Deployment September 18, 2012

  2. Participants Production/Deployment Project Participants • Allscripts (EHR) • Athenahealth (EHR) • Cerner (EHR/LIS/HIE) • OPTUMInsight (HIE/EHR) • RML (LIS) • LabCorp (LIS) • Halfpenny Technologies (Integrator) • ARUP (LIS) Coordination of Effort • Validation Suite • Vocabulary Group • Implementation Guide Updates • LRI/LOI/eDOS Workgroups • Support Team Pilot II Project Participants Conversations • Lab System and EHR Vendor (2) • Lab System Vendor (1) • EHR Vendor (4) • Commercial Laboratories (1) • Provider Based Commercial Labs (2)

  3. Agenda Updates on Laboratory Activity • eDos update • Validation Suite update • Vocabulary Workgroup update • LRI – DSTU artifacts • LOI – Status • Next Steps

  4. eDOS Workgroup Pilots – Updates Patrick Loyd

  5. eDOS Summary • eDOS: Provides an electronic interchange of a laboratory’s Directory of Services (DOS) in a structured format based on HL7’s master file update found in Chapter 8 of version 2.6. This implementation guide, initially developed by the members of the American Clinical Laboratory Association’s (ACLA) in conjunction with their Health Information Technology (HIT) Committee, is intended to provide all necessary information to help an Ordering Provider properly request laboratory tests consistent to aide patient diagnosis. • The eDOS work effort will: • Validate that the current Informative Implementation Guide meets the objective through a pilot of eDOS • Align the IG with the in-scope tests in the Lab Result Interface (LRI) IG • Incorporate pilot findings to update the Implementation Guide to develop a normative document to be balloted based on HL7’s ANSI process. • The Normative IG is intended to support the efforts of the Lab Order Interface (LOI) IG and the Lab Result Interface (LRI) IG by providing the services necessary to meet the needs of the users of those guides.

  6. Background 6 • eDOS, or the Laboratory Test Compendium Framework, provides an electronic interchange of a laboratory’s directory of services in a structured format based on HL7’s master file update. • An Implementation Guide was developed by the members of the American Clinical Laboratory Association (ACLA) in conjunction with their Health Information Technology (HIT) Committee to provide all necessary information to help an Ordering Provider properly request laboratory tests consistent to aide patient diagnosis. • The eDOS IG is available as an informative document from HL7 • The LOI Tiger Team identified the importance of coordinating the LOI and eDOS efforts so that LOI can validate the eDOS IG as part of the LOI alignment activities • To ensure that the eDOS efforts don’t delay the LOI Initiative, the Tiger Team decided to spin off a separate eDOS Work Group to focus on eDOS

  7. eDOS – Pilot Project • Use Case Review – Work Group • 42 participants • 8 calls • 30 companies represented • eDOS Pilot Projects • Current in recruiting mode • 75% + Intersection with LRI, LOI • Kickoff Call for Pilot Candidates/Participants - October 2, 2012 • More information • Web: http://wiki.siframework.org/LOI+-+eDOS • Pilot Co-Chairs: patrick.e.loyd@gmail.com, freida.x.hall@questdiagnostics.com

  8. SPM-21 Recommendations • SPM-21 is the Specimen Reject Reason • Continue with current Note: language “will” (e.g. do not change this to “may”). This is important and lab support for SPM-21 must be included at some point with future versions of the IG. • This group will update table 0490 with additional codes and Ken will take the additions back to HL7 • Work with Rob Snelick to ensure that the juror documents include appropriate display and interpretation of the SPM-21

  9. Reflex testing recommendations • Reflex testing may be represented in the result transaction as 1) one or more additional OBXs as part of an existing OBR or 2) one or more additional OBR/OBX(s) using the existing or a new ORC. • In the event method two is used (one or more additional OBR/OBX(s)), then the OBR must be referenced to the original OBR (using the parent-child relationship via the unique identifier in OBR-2 or using OBR-2/OBR-4 if OBR-2 is not unique ) with the same date specimen was collected or obtained. (OBR-7 in new OBR must be the same as the referenced original OBR-7) • Explore LOI messaging to communicate new order to EHR prior to sending result message.

  10. Definitions from LRW – in process • Reference Display/Report (“Report of Record”?) • For the final report destination, a single display and printed report version of the laboratory report that contains all of the information required by CLIA in a format that is easily interpreted by the intended audience in a manner that is consistent with the intent of the performing laboratory. • If the display version does not contain all of the required CLIA information on one visible display, the additional information must be available with a single additional motion (e.g. scroll, hover, click). • This is the display and report that must, as a minimum be used by EHR certification for validation of CLIA compliance

  11. Validation Suite • Validation Suite Incorporation of updated DSTU LRI • Provide tool for public review by 10/31/2012 • Coordination of effort with Public Health • Testers and feedback for current version of Validation Suite tool http://lri.sipilotdevelopment.org/lri-dstu/

  12. LRI • All required comments review and addressed • V.49 submitted to HL7 for adoption as DSTU guide on 7/15 • Formally adopted on 7/15/2012 • Access LRI IG via link on Pilots home page • Final 30 minutes of Tuesday and Thursday LOI weekly call will address any LRI Pilot issues • To ask clarifying questions on the LRI IG guide, you can submit them through http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=81, the official HL7 page for DSTU comments for this LRI IG, or send an e-mail to either of the IG or Pilot workgroup co-leads: • hans.buitendijk@siemens.com • kenneth.h.mccaslin@questdiagnostics.com • rdieterle@enablecare.us • Feedback from either of these sources will be captured into HL7 Orders & Observations workgroup's wiki pages where we will track resolutions http://wiki.hl7.org/index.php?title=Category:OO_Change_Requests • Submit questions at http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=81

  13. LOI Status • LOI • Use Case Consensus complete • LOI/LRI Alignment by tiger team is complete • Initial work with full LOI workgroup on 9/18

  14. Next Steps / Questions • Next Steps • Work with Public Health on expanded scenarios for validation suite • Ask for help if need partner • Schedule • Calls for coordination every other week at same time next call 10/2 at 2pm Eastern • Includes eDOS kick-off • Continue work with Validation Suite • Continue participation in LOI • For questions, please feel free to contact • Bob Dieterle: rdieterle@enablecare.us

  15. “Parking Lot Issues” • Standardization of methodology or normalization of results and normal ranges • E.g. PSA normal is 0-4 for both methodologies • 8 methods for hgb what is variability for normal ranges

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