Microbiology Discrete Results Reporting Presenters: Tymn Neece Sonal Pandey Lancaster General Hospital Lancaster, Pa

Text Based Results Hybrid Results Structured Discrete Micro Result Reporting Options

Help achieve the MU requirements for Structured data Improve result layout in EMR Infectious Disease Reporting EMR report writer resource Reports can be written by patient location and organism identified Tie pharmacy data to positive cultures for Drug effectiveness monitoring Why would I ever want to do this?

Become best friends with your EMR support staff (send flowers, bake cookies!!) Include your Interface Engine Staff Determine what your EMR and connected systems are capable of displaying Don’t forget any systems or organizations connected to your outbound results feed Take good notes – write everything down Write a good Validation plan Planning for Success

OBR 4 – Order Procedure 4.1 – HIS code 4.2 – Order Name OBR 15 - Specimen Source OBR 25 – Result Status F = Final P = Preliminary C = Corrected HL7 Basics OBR Segments

HL7 Basics OBR Segment OBR 4OBR 15 OBR 25

OBX 2 - Value type ST = String Data SN = Structured Numeric CWE = Coded element TX = Textual Data HL7 Basics OBX Segments

OBX (O) Organism/Isolate Identification OBX 4 – Observation Sub ID (Isolate #) Links the Organism to the MIC Important when multiple organisms are identified OBX 5 – Observation Identifier(Organism ID ^Name) OBX 5 – Observation Value 5.1 – Identifier – can be SNOMED or LOINC or Local Text – description of organism 5.3 – Name of coding system 5.4/5.5/5.6 – Alternate Identifier/Text/Coding system HL7 Basics OBX Segments

OBX4OBX5

OBX (Q) Isolation Quantitation OBX 4 Observation Sub ID(isolate #) OBX 5 Observation value(quantitation) HL7 Basics OBX Segments

ORC (ORC(S)) Antibiotic Sensitivity Panel –LGH removed this. Incompatible with Epic OBR(OBR(S)) Antibiotic Sensitivity Panel –OBR 3.1 Entity Id(filler and Organism ID) –OBR 4 – Ordered Procedure – OBR 4 (in 2nd OBR) MIC or KB HL7 Basics Sensitivity Segments

OBX(OBX(S)) Antibiotic Sensitivity –OBX 2 – value type is Structured Number –OBX 3 – Antibiotic –OBX 4 – Isolate # –OBX 5 (5.1 – 5.4) Comparitor/Number/Separator(suffix)/Number –OBX 6 – Units –OBX 6 (6.1 – 6.3 ) Units Identifier/Text/coding system HL7 Basics OBX Sensitivity Segments

OBX 2OBX 3OBX 4OBX 5OBX 6

Flagging Abnormal results in HIS OBX 8.1 Abnormal Flag Isolate level flagging “A” sent out for abnormal alphanumeric

Flagging Abnormal results in EPIC

Susceptibility Table in EPIC

Flagging Abnormal results in Epic Results marked as “Significant” manually

Uses a mix of micro discrete results and formatted text display DSP segments format text to send to the HIS. Micro Discrete Display in Cerner

Cerner Microview - Organisms Micro Discrete Display in Cerner

Susceptibilities Sent in OBX segments display in Powerchart

Quantitations and Comments sent in DSPs Micro Discrete Display in Cerner

Discrete Micro Message Structure Soft Specifications Structure Structure

Gram Stain

Questions