A Lab-EMR Interoperability Profile for Resource Constrained Settings William Lober, MD MS Associate Professor International Training and Education Center on Health University of Washington, Seattle, WA, USA

Premises Interoperability is good

Premises Interoperability is good Standards are not sufficient

Standards not Sufficient accessed 14-Sep-2010

Premises Interoperability is good Standards are not sufficient eHealth Architecture is good

Interoperability Showcase Courtesy of JEMBI, Canada Health Infoway, etc… (Thanks!)

eHealth architecture requires understanding of… Components – e.g. Lab Information Systems – e.g. Electronic Medical Record Systems Information Exchange between components – e.g. Lab-EMR Guidance to implement information exchange – e.g. Interoperability profile

Interoperability Profile “An interoperability profile is a structured description of the content, format, and method of an information exchange, and of the business rules governing that exchange.” - Lober, 2010-Sep

Interoperability Profile “An interoperability profile is a structured description of the content, format, and method of an information exchange, and of the business rules governing that exchange.” - Lober, 2010-Sep “Profiles are not standards; they describe the use of standards”

Interoperability Profile Borrowed from IHE framework ( – Commercial participants – Comprehensive coverage of use cases, transactions – Message-based and document-based approaches – Rich, expressive, based on present practice – …Complex

IHE page

Interoperability Profile Borrowed from IHE framework ( – Commercial participants – Comprehensive coverage of use cases, transactions – Complex But, despite excellent standards & frameworks, many systems use… Local vocabularies Local formats Local protocols Feasibility of a simpler approach to implementing standards…?

Interoperability Profile Borrowed from IHE framework ( – Commercial participants, comprehensive – Complex, cost of standards compliance These profiles are simpler, and contain… – Actors, whose actions are described in – Use cases, which are implemented using – Transactions, which are based on standards

Interoperability Profile Borrowed from IHE framework ( – Commercial participants, comprehensive – Complex, cost of standards compliance These profiles are simpler, and contain… – (Fewer) Actors, whose actions are described in – (Fewer) Use cases, which are implemented using – (Simpler) Transactions, which are based on (constrained) standards

Interoperability Profile Borrowed from IHE framework ( – Commercial participants, comprehensive – Complex, cost of standards compliance These profiles are simpler, and contain… – (Fewer) Actors, whose actions are described in – (Fewer) Use cases, which are implemented using – (Simpler) Transactions, which are based on (constrained) standards Profiles are not standards, they describe the use of standards…

Lab Profile Simplified Use Cases Fewer Actors Prioritized Transactions Phased Implementation

Lab Profile – Logical Order of Use Case Patient Identification – Patient Index (PIX) Profile – Patient Demographic Query (PDQ) Profile Order Transmission – Laboratory Testing Workflow (LTW) Profile Results Transmission – Laboratory Testing Workflow (LTW) Profile

Use Case

Lab Profile – Simplified Use Cases (in 3 implementation phases) Order Transmission on Paper Results Transmission Order Transmission on Paper Identification of Patient in EMR Result Transmission Order Transmission Identification of Patient in EMR Identification of transmitted order Result Transmission Electronic Medical Record Lab Information System Order (Paper) Demographic Query Demographic Response Test Result

Transaction Set Identification of Patient in EMR – PDQ Profile (ITI-21 transaction) HL7 QBP^Q22 message for Query HL7 RSP^K22 message for Result Result Transmission – LTW Profile (LAB-3 transaction) Filler Order created by the laboratory (w/o notification) HL7 ORU^R01 message for Result (matched on Patient ID, not order number)

3 examples OpenELIS OpenMRS OpenELIS iSante OpenELIS Health Infoway

OpenELIS OpenMRS Module for OpenMRS to implement profile Anyone want to implement…? Electronic Medical Record Lab Information System Order (Paper) HL7 QBP^Q22 HL7 RSP^K22 HL7 ORU^R01

OpenELIS iSante Haiti (55+ sites) – OpenELIS in 7 labs Used by Pharmacy, Patient Transfer, Lab Electronic Medical Record Lab Information System Order (Paper) Query (http post, REST) Response (XML) Result (ORU^R01)

OpenELIS Health Infoway Lab

Discussion Light(er) weight, simpler set of transactions The profile describes information interaction in three settings Patterns… Questions – Does it work in a wider set of implementations? – Does it help other developers? – Does it aid in understanding the information exchange?

In conclusion Interoperability is good Standards are not sufficient Profiles are not standards, they describe the use of standards… Describing things is good.

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