Lessons Learned Interfacing SoftBank to Foreign LIS

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Presentation transcript:

Lessons Learned Interfacing SoftBank to Foreign LIS Standalone SoftBank Brenda Duff, CMT

Standalone SoftBank The popularity and advanced features of SoftBank have led to many organizations adding SoftBank as a module or replacing their current Blood Bank module without changing the LIS system Unique constraints exist when SoftBank is interfaced with a Foreign LIS system. Many of these constraints from foreign systems are mitigated by Client Interface Engines. Different Clients with the same LIS system may handle these constraints in different ways depending on their LIS system setups and Workflows.

Standalone SoftBank with Foreign LIS systems SoftBank is not the Phlebotomy System. Specimens are collected and received in the Foreign LIS. We Collect and receive in Bank as well. SoftBank must utilize Foreign LIS Barcodes on Instrumentation Alternatively an order number label can be printed from Soft Bank and placed on the tube. Merging Ordered Tests into the Same Order/Accession/Specimen Number is controlled by the foreign system.

Standalone SoftBank with Foreign LIS systems, cont’d SoftBank is constrained to Order, Reflex and Add- On in SoftBank based on foreign system requirements. This impacts SoftBank workflows. Adding confirmation blood type in example Most Foreign LIS systems are setup to interface to SoftBank as reference lab style interfaces and not customized foreign blood bank module interfaces Workflow impacts: Going to foreign LIS system to add-on, collect/receive/ etc… Reference Lab interfaces: Specimen in hand for Tests that are not performed. Order and Specimen Sent to Reference Lab and results returned. The reference lab does not collect specimens. Many Reference Lab reflex tests are also built within the same group as components that are not reported unless results received. This negates the need for reflexing orders.

Standalone SoftBank with Foreign LIS systems, cont’d Many Foreign LIS systems do not allow creation of specimens from foreign systems with reference lab style interfaces. Reflex and Add-On testing differs significantly depending on the foreign LIS Foreign LIS systems SoftBank has interfaced with: Sunquest LIS McKesson Horizon HLAB Epic Beaker LIS Cerner

Standalone SoftBank w/o Foreign LIS system In many instances, interfacing with another LIS is not wanted and SoftBank interfaces directly with the HIS system. Phlebotomy now resides in SoftBank. Standard HIS interfaces do not have the same constraints as Foreign LIS constraints.

SoftBank Orders Interface Features SoftBank can accept discrete data fields for relevant information from the HIS systems. Reason For Transfusion Transfusion Needed Date Special Instructions CMV negative Blood HLA matched Blood Irradiated Blood ETC…

SoftBank Orders Interface Features These discrete data fields typically will require client interface engine modification of Orders messages to provide the data to SoftBank. Many LIS and HIS systems have limitations on providing this data in the needed Order Test Level discrete data fields. The versatility of these Question/Answers in the HIS/LIS system lends to modifications available at any time. Client interface engine mitigate these changes within the client’s organizational change control as opposed to embedding these modifications in the Soft interfaces requiring SCC change control.

SoftBank Product Results interface features SoftBank provides different formats of results messages Short/Long Text Discrete Extended discrete Textual formats Message indicator that the result is for a Product

SoftBank Product Results interface features Extended discrete has become more popular as many HIS systems are able to post the data in individual discrete fields. Unit Donation Number, Unit ABO/RH Type, Unit Expiration, Unit compatibility, etc… ISBT coded data Product Code, Blood Type Codabar coded data Product Code, Blood Type, Registration Individual Unit Status Selected, Issued, Transfused and Released The ability to send all this discrete information from SoftBank is dependent on SoftBank version.

SoftBank Product Results interface features A single product result message may contain many units. Number of units that a message can contain depends on foreign system posting.

SoftBank Test Results interface features Automatic reflexing Specimen Outdate Message indicator that the result is for a Test or Action (i.e. RhIg)

Other SoftBank Interfaces SoftID Tx Hematology Query Result Posting Physician Update (MFN)

SoftIDTx SoftIDTx Vitals can also be sent from SoftBank interfaces. Transfusion Start Date/Time Transfusion End Date/Time Patient Vitals Transfusion Volume Automated Transfusion Reaction Workup Ordering based on Vitals

SoftBank Hematology Query SoftBank Transfusion History Reports have the ability to pull in Hematology Results Hematology Results are routed from the Foreign LIS to Soft HIS interfaces and posted via Soft customized Hematology Results posting “instrument” interface

SoftBank Hematology Query This interface is simple, only designed to post the numeric data from results such as HGB, HCT, PLT, PT/INR, aPTT and Fibrinogen. Results are not posted to the SoftBank database. SoftBank queries the “instrument” database for the results.

SoftBank Hematology Query: Client Typical Setup Client interface engine “copies” results messages to SoftBank when the department indicates Hematology from the Main LISHIS results interface. Client interface engine converts messages to Hematology Query format for posting.

Master File Notification for Physician Update Many large institutions have high physician turn- over, particularly those with Residency Programs. Soft MFN interface for Physician Update allows an automated means to keep the SoftBank Doctor Setup in Sync with the Hospital Physician Management system.

Master File Notification for Physician Update Soft Physician Update interface allows: Adding Doctors Activating/Deactivating Doctors Updating Doctor’s information [Deleting Doctors]

HL7 formats Soft supports HL7 versions to v2.5.1 Most Standalone SoftBank interfaces are specified for HL7 v2.4 HL7 v2.5.1 has many features/fields that are not supported by SoftBank. HL7 v2.4 has enough information to provide comprehensive interface features without additional data fields to validate which may be unnecessary. SoftBank is only communicating with the one foreign LIS system as a module. It does not typically communicate with any foreign system outside of the client organization directly.

HL7 v2.4 Extended Discrete Product message. MSH|^~\&|BB|SCC|HISAPP|HIS01|201510151450||ORU^R01|0000001|P|2.4| PID|1||123456789||ZZTESTSOFTÎNTERFACE||19850101|M||W||5400^TECHDATA^ROAD^FL^CLEARWATER^33760ÛSA^^L||(727)789-0100^^^^^727^7890100|(727)789-0100^^^^^727^7890100||||2003010008447| PV1|1|I|WARD^ROOM^BED|||SCCDOC^DOCTOR^SOFT|||||||||||SCCDOC^DOCTOR^SOFT||||||||||||||||||||||||||201509220805|(727)7890100^^^^^727^7890100||||| 201509220826||MBB|P| ORC|RE|1000001ÊPC| SCC00001-01| SCC00001|||||201509210934|HIS||SCCDOC^DOCTOR^SOFT| OBR|1|1006351| SCC00001-01|RC^Red Blood Cells|||201509211116|||NUR|L|||||SCCDOC^DOCTOR^SOFT|(727)7890100^^^^^727^7890100||||PRODUCT| OBX|1|TX|UNITÛNIT AND STATUS|1|W095414900950 Issued||||||P|||201509211120| OBX|2|ST|UTYPEÛNIT ABO |1|POS||||||P|||201509211120||SCC| OBX|3|ST|URHÛNIT RH |1|POS||||||P|||201509211120||SCC| OBX|4|ST|UPROD^PRODUCT CODE DESCRIPTION|1|RED BLOOD CELLS|||||||P|||201509211120||SCC| OBX|5|ST|UNIT^DONATION NUMBER|1|W095414900950|||||||P|||201509211120||SCC| OBX|6|ST|UBPRD^BARCODED PRODUCT CODE|1|E0316V00|||||||P|||201509211120||SCC| OBX|7|ST|USTATÛNIT STATUS|1|Issued|||||||P|||201509211120||SCC| OBX|8|ST|UBTYP^BARCODED ABO/RH|1|5100|||||||P|||201509211120||SCC| OBX|9|ST|UEXPÛNIT EXPIRATION|1|20150826|||||||P|||201509211120||SCC| OBX|10|TX|UNITÛNIT AND STATUS|2|W095414888830 Transfused ||||||F|||201509211120| OBX|11|ST|UTYPEÛNIT ABO|2|O||||||F|||201509211120||SCC| OBX|12|ST|URHÛNIT RH|2|POS||||||F|||201509211120||SCC| OBX|13|ST|UPROD^PRODUCT CODE DESCRIPTION|2|RED BLOOD CELLS|||||||F|||201509211120||SCC| OBX|14|ST|UNIT^DONATION NUMBER|2|W095414888830|||||||F|||201509211120||SCC| OBX|15|ST|UBPRD^BARCODED PRODUCT CODE|2|E0316V00|||||||F|||201509211120||SCC| OBX|16|ST|USTATÛNIT STATUS|2|Transfused|||||||F|||201509211120||SCC| OBX|17|ST|UBTYP^ BARCODED ABO/RH|2|5100|||||||F|||201509211120||SCC| OBX|18|ST|UEXPÛNIT EXPIRATION|2|20150930|||||||F|||201509211120||SCC|

ORMC’s Major Issue

HL7 v2.5.1 Extended Discrete Product Message MSH|^~\&|SOFTBANK^2.16.840.1.113883.3.3013.77.3ÎSO|HMHSOFT^2.16.840.1.113883.3.####|EPIC^1.2.840.114350ÎSO|HIS01^2.16.840.1.113883.3.####ÎSO|201509220827||ORU^R01|0000001- 201509220827|D|2.5.1|||AL|NE|LRI_NG_RN_Profile^HL7^2.16.840.1.113883.9.20ÎSO PID|1||123456789^^^MRN&1.2.840.114350&ISO^MR^HIS01&2.16.840.1.113883.3.####&ISO||ZZTESTSOFTÎNTERFACE|^^^^^^M|19850101|M||2106- 3^White^HL70005^C^White^L|5400^TECHDATA^ROAD^FL^CLEARWATER^33760ÛSA^^L||^PRN^PH^^^727^7890100|||||2003010008447|||||||||||||||201509220805 PV1|1|I|WARD^ROOM^BED^|L|2003010008447||SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO||||||||||SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^ ^DN^CLIENT&2.16.840.1.113883.3.####&ISO|I||||||||||||||||||||||||||201508260000 ORC|RE|1000001ÊPC^1.2.840.114350ÎSO|SCC00001- 01ÔRDNUM^2.16.840.1.113883.3.3013.25.78ÎSO|SCC00001ÔRDNUM^2.16.840.1.113883.3.3013.25.78ÎSO|||||201509210934|HIS||SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.#### &ISO|DSIC|^WPN^PH^^^727^7890100~ÔRN^FX^^^727^7890124~^NETÎnternet^sales@softcomputer.com|||||||SOFT WARD^L^^^^^XX^^^HIS01|^^^^^^B|^WPN^PH^^^727^7890100|5400 TECHDATA DR^^CLEARWATER^FL^33760ÛSA OBR|1|1006351ÊPC^1.2.840.114350.430.8ÎSO|SCC00001-01ÔRDNUM^2.16.840.1.113883.3.3013.25.78ÎSO|933-2^Blood product type^LN^RC^Red Blood Cells^L^2.46^NA^Red Blood Cells|||201509211116|||NUR|L|||||SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO|^WPN^PH^^^727^7890100~ÔRN^FX^^^727^7890124~^NETÎnternet^sales@softcomputer .com||||PRODUCT|201509220826||MBLB|P|||||||||||||||||||||| TQ1|1||||||201509210935|201509210935|R OBX|1|TX|933-2^Blood product type^LNÛNIT^Red Blood Cells^L^2.46^NA^Blood product type ||W095414900950 Issued||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|2|ST|933-2^Blood product type^LNÛPROD^PRODUCT CODE^L^2.46^NA^Blood product type |1|RL5^Red Blood Cells, AS-1||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|3|ST|934-0^Blood product unit ID [#]^LNÛNIT^DONATION NUMBER^L^2.46^NA^Blood product unit ID [#]|1|=W095414900950||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|4|ST|936-5^Blood product unit [Identifier]^LNÛBPRD^BARCODED PRODUCT CODE^L^2.46^NA^Blood product unit [Identifier]|1|=<E0316V00||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|5|ST|925-8^Blood product disposition [Type]^LNÛSTATÛNIT STATUS^L^2.46^NA^Blood product disposition [Type]|1|Issued||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|6|ST|14577-1ÂBO and Rh group [Type] in Blood from donor^LNÛBTYP^BARCODED ABO/RH^L^2.46^NA^ ABO and Rh group [Type] in Blood from donor|1|=%5100||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|7|ST|14577-1ÂBO and Rh group [Type] in Blood from donor^LNÛTYPEÛNIT ABO/RH^L^2.46^NAÂBO and Rh group [Type] in Blood from donor^LNÛTYPEÛNIT ABO/RH |1|O POSITIVE||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|8|ST|52113-8^Blood product unit expiration [Date and time]^LNÛEXPÛNIT EXPIRATION^L^2.46^NA^Blood product unit expiration [Date and time]|1|20150826||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|9|TX|933-2^Blood product type^LNÛNIT^Red Blood Cells^L^2.46^NA^Blood product type ||W095414888830 Issued||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|10|ST|933-2^Blood product type^LNÛPROD^PRODUCT CODE^L^2.46^NA^Blood product type |2|Apheresis Red Cell AS3 #2 LR||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|11|ST|934-0^Blood product unit ID [#]^LNÛNIT^DONATION NUMBER^L^2.46^NA^Blood product unit ID [#]|2|W095414888830||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|12|ST|936-5^Blood product unit [Identifier]^LNÛBPRD^BARCODED PRODUCT CODE^L^2.46^NA^Blood product unit [Identifier]|2|=<E0686V00||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|13|ST|925-8^Blood product disposition [Type]^LNÛSTATÛNIT STATUS^L^2.46^NA^Blood product disposition [Type]|2|Issued||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|14|ST|14577-1ÂBO and Rh group [Type] in Blood from donor^LNÛBTYP^BARCODED ABO/RH^L^2.46^NA^ ABO and Rh group [Type] in Blood from donor|2|5100||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|15|ST|14577-1ÂBO and Rh group [Type] in Blood from donor^LNÛTYPEÛNIT ABO/RH^L^2.46^NAÂBO and Rh group [Type] in Blood from donor^LNÛTYPEÛNIT ABO/RH |2|O POSITIVE||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|16|ST|52113-8^Blood product unit expiration [Date and time]^LNÛEXPÛNIT EXPIRATION^L^2.46^NA^Blood product unit expiration [Date and time]|2|20150930||||||P|||201509220826|||||201509220826||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA 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[Type]|1|Issued||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|6|ST|14577-1ÂBO and Rh group [Type] in Blood from donor^LNÛBTYP^BARCODED ABO/RH^L^2.46^NA^ ABO and Rh group [Type] in Blood from donor|1|=%5100||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA DR^^CLEARWATER^FL^33760ÛSA|SCCDOC^DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.114350&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.####&ISO OBX|7|ST|14577-1ÂBO and Rh group [Type] in Blood from donor^LNÛTYPEÛNIT ABO/RH^L^2.46^NAÂBO and Rh group [Type] in Blood from donor^LNÛTYPEÛNIT ABO/RH |1|O POSITIVE||||||P|||201509211120|||||201509211120||||HOME MAIN HOSPITAL^D^^^^MLAB&2.16.840.1.113883.3.####&ISO^XX^^^MLAB|5400 TECH DATA 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HL7 v2.4 vs v2.5.1 OBR segment OBR|1|1006351| SCC00001-01|RC^Red Blood Cells|||201509211116|||NUR|L|||||SCCDOC^DOCT OR^SOFT|(727)7890100^^^^^727^7890100||||PROD UCT| OBR|1|1006351^NSID^2.16.840.1.113883.3.301 3.77.3ÎSO|SCC00001- 01ÔRDNUM^2.16.840.1.113883.3.3013.25.##Î SO|933-2^Blood product type^LN^RC^Red Blood Cells^L^2.46^NA^Red Blood Cells|||201509211116|||NUR|L|||||SCCDOC^ DOCTOR^SOFT^^^MD^^^DRIDAA&1.2.840.1143 50&ISO^L^^^DN^CLIENT&2.16.840.1.113883.3.# ###&ISO|^WPN^PH^^^727^7890100~ÔRN^FX ^^^727^7890124~^NETÎnternet^sales@softco mputer.com||||PRODUCT|201509220826||MB LB|P||||||||||||||||||||||

Non-Interface Scenarios Most Downtime scenarios involve paper requisitions and paper workflow. Variations in Client Policy and Procedures lead to many different Scenarios Mass-Transfusion Protocols, Trauma Protocols and Emergency Release Protocols vary significantly depending on Client workflow and foreign system limitations. This can lead to not utilizing the interface for these events. Work with you HIS implementer to see which workflows will work with the interfaces and which will not.

High-Level Epic Beaker

High-Level McKesson HLAB

High-Level Sunquest

High-Level GE HIS

High-Level CPSI HIS

Low-Level Epic Beaker Orders/Results/Billing Only

Low-Level Epic Beaker Orders/Results/Billing/Hematology Query/ MFN Doctor/SoftDonor