Feb. 9, 2005 IHE Educational Meeting 1 IHE LCSD Profile – Laboratory Code Set Distribution Based on HL7 version 2.x, Chapter 8 Jean-Christophe Cauvin, France René Spronk, Ringholm GmbH IHE Laboratory Planning and Technical Committee

Feb. 9, 2005IHE Educational Meeting 2 Laboratory IHE Integration Profiles In Process –TI Nov 2004 Laboratory Device Automation (LDA) In Process –TI Nov 2004 Pre-analytic process, analysis and post-analytical treatment Laboratory Scheduled Workflow (LSWF) Completed in 2003 Tests performed by a laboratory for an identified inpatient or outpatient In Process Laboratory Information Reconciliation (LIR) In Process Tests performed on an unidentified or misidentified patient Laboratory Code Set Distribution (LCSD) Sharing the batteries and tests code sets throughout the enterprise In Process –TI Nov 2004 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed on point of care or patient’s bedside

Feb. 9, 2005IHE Educational Meeting 3 LSWF: Workflow Technical validation Clinical validation Selected standard: HL7 version 2.5

Feb. 9, 2005IHE Educational Meeting 4 The Laboratory Technical Framework Laboratory Code Set Distribution

Feb. 9, 2005IHE Educational Meeting 5 Laboratory Code Set Distribution The goal of this profile is to simplify the configuration of the systems involved in the Laboratory Scheduled Workflow. The Laboratory Code Set Distribution Profile offers the means to share the same set of test/observation codes between different actors. Other information can be also exchanged like presentation of results, laboratory codes (in which lab a test is performed), units …

Feb. 9, 2005IHE Educational Meeting 6 Laboratory Code Set Distribution Actors/Transaction Laboratory Code Set Master LAB-xx: Laboratory Code Set Management Laboratory Code Set Consumer Order Filler Enterprise Common Repository … Order Placer Order Result Tracker Automation Manager Order Filler …

Feb. 9, 2005IHE Educational Meeting 7 Replaces Observation/Test/Battery Code Sets All Observation, Test and Battery code sets of the Consumer are replaced by the code sets sent by the Master. This Use Case is used both for initialization as well as periodic (weekly, monthly) update. Laboratory Code Set Distribution Use Case 1 Laboratory Code Set Master Laboratory Code Set Consumer Creates observation/test/battery codes Laboratory Code Set Management (REP)

Feb. 9, 2005IHE Educational Meeting 8 Laboratory Code Set Distribution Use Case 2 (out of scope for this year) Laboratory Code Set Master Laboratory Code Set Consumer Updates observation/test/battery codes Laboratory Code Set Management (UPD) Updates Observation/Test/Battery Code Sets Observation, Test and Battery codes of the Consumer are updated by codes sent by the Master. Updates are at the record level : add record(s), delete record(s), update record(s).

Feb. 9, 2005IHE Educational Meeting 9 Laboratory Code Set Distribution Use Case 3 (out of scope for this year) Laboratory Code Set Master Laboratory Code Set Consumer Unknown / Expired observation/test/battery codes Laboratory Code Set Management Query for Observation/Test/Battery Code Sets The Laboratory Code Set consumer either periodically queries for the entire codeset, or it queries for the details of specific Observation, Test and Battery codes. The query responses are used to update the code set are at the record level : add record(s), delete record(s), update record(s). Query for Laboratory Code Set

Feb. 9, 2005IHE Educational Meeting 10 Laboratory Code Set Distribution Standard Interactions based on HL7 V2.5, Master Files (chapter 8). Advantages of using HL7 V2.5: HL7 is already implemented on laboratory systems; no need to implement a new protocol Master Files are already adopted by some vendors. Messages are rich enough to transport other information than just observation/test/battery codes : presentation of the results laboratory codes units of measure

Feb. 9, 2005IHE Educational Meeting 11 HL7 Master Files Master files are a set of common reference files used by one or more application systems. Some common examples of master files in the healthcare environment include: staff and health practitioner master file location (census and clinic) master file lab test definition file exam code (lab, radiology) definition file

Feb. 9, 2005IHE Educational Meeting 12 Generic MFN – Abstract Message MSH MFI Master File Identification { MFE Master File Entry [ <other resource related segments, e.g. LOC > ] } MFIMFELOC 1..n 0..n

Feb. 9, 2005IHE Educational Meeting 13 Generic MFN – Location Example MSH|^~\&|MyHIS||PhysioApp|| ||MFN^M05|31|P|2.4||AL|NE MFI|LOC|EH_Locations|UPD|||ER MFE|MDL|M226||Aqua1^^^Eastern Hospital^^^Physio^B^ Aqua therapy room 1|PL LOC|Aqua1^^^Eastern Hospital^^^Physio^B^Aqua therapy room 1||L MFE|MUP|M227||Aqua2^^^Eastern Hospital^^^Physio^B^ Aqua therapy room 2|PL LOC|Aqua2^^^Eastern Hospital^^^Physio^B^Aqua therapy room 2| Aqua therapy room 2|L|Eastern Hospital| LDP| Aqua2^^^Eastern Hospital^^^Physio^B^Aqua therapy room 2|PHY^ Physiotherapy||REH~PRE|D~O|

Feb. 9, 2005IHE Educational Meeting 14 Generic MFN Event Codes MFI – File Level Event Codes REP:Replace current version of this master file with the version contained in this message. UPD:Change file records as defined in the record-level event codes for each record that follows. (out of scope for this year) MFE – Record Level Event Codes MAD:Add record to master file. MDL:Delete record from master file. MUP:Update record for master file. MDC:Deactivate: discontinue using record in master file, but do not delete from database. MAC:Reactivate deactivated record.

Feb. 9, 2005IHE Educational Meeting 15 Generic MFK – Acknowledgment MSH MSA Message Acknowledgement [ERR] MFI Master File Identification { [MFA] Master File Acknowledgement } MFIMFA 0..n MFIMFELOC 1..n 0..n Only in case of errors in related MFE/LOC

Feb. 9, 2005IHE Educational Meeting 16 Generic MFK Ack, Location Example MSH|^~\&|FysioApp||MyZIS|| ||MFK^M05|31|P|2.4| |AL|NE MFI|LOC|EH_Locations|UPD|||NE MFA|MDL|M226||U^Location not present| Aqua1^^^Eastern Hospital^^^Physio^B^Aqua therapy room 1|PL (NOTE: successful changes are NOT acknowledged) MFA|MUP|M227||S|Aqua2^^^Eastern Hospital^^^Physio^B^Aqua therapy room 2|PL

Feb. 9, 2005IHE Educational Meeting 17 Laboratory Code Set Distribution LAB-XXX Message Structures MFN^M08 – Master File Notification – Test/Observation (Numeric) MSHMessage Header[1..1]chap. 2 MFIMaster File Identification[1..1]chap. 8 {[1..*] MFEMaster File Entry[1..1]chap. 8 OM1General Segment[1..1]chap. 8 [OM2] Numeric Observation Segment[0..1]chap. 8 } MFN^M09 – Master File Notification – Test/Observation (Categorical) MFN^M10 – Master File Notification – Batteries MFN^M11 – Master File Notification – Test/Calculated Observation [OM3] Categorical Test/Obs. Segment[0..1]chap. 8 [OM5] Observation Batteries[0..1]chap. 8 [OM6 Obs. calculated from other Obs.[0..1]chap. 8 OM2] Numeric Observation Segment[0..1]chap. 8

Feb. 9, 2005IHE Educational Meeting 18 OM1-2Producer’s Service/Test/Observation ID OM1-4Specimen required OM1-5Producer ID OM1-18Nature of Service/Test/Observation: P battery, A atomic, S super-set of batteries, C single observation calculated OM1-19Report sub-header OM1-20Report display order OM2-2Units of Measure OM2-3Range of Decimal Precision Laboratory Code Set Distribution OM1 – General Segment OM2 – Numeric Observation Segment

Feb. 9, 2005IHE Educational Meeting 19 OM3-2Preferred Coding System OM3-3Valid Coded answers OM3 – Categorical Service/Test/Observation Segment Laboratory Code Set Distribution OM5 –Observation Batteries Segment OM5-2Tests/observations included within Battery OM6 –Observation that are Calculated OM6-2Derivation Rule

Feb. 9, 2005IHE Educational Meeting 20 Atomic Tests, Numeric Results MSH|^~\&|OF|LabSystem|OP|| ||MFN^M08|2106|2.5|||NLD|8859/1|NL| MFI|OMA|OF_OMA_NL_ |REP|||ER| MFE|MAD|1846||1846^CREABL/Creatinine^L|CE| OM1|1|1846^CREABL/Creatinine^L|NM|Y|K231^Klinisch Chemisch Laboratorium^?|||Creatinine||||||||||A| OM2|1|umol/l|6.0|| OM4|1||stolbuis rode dop4||ml|^volbloed| MFE|MAD|1848||1848^CREAUV/Creatinine^L|CE| OM1|2|1848^CREAUV/Creatinine^L|NM|Y|K231^Klinisch Chemisch Laboratorium^?|||Creatinine||||||||||A| OM2|2|mmol/l|6.0|| OM4|2||24-uurs bokaal|||^urine verzamel|

Feb. 9, 2005IHE Educational Meeting 21 Test with derived result MSH|^~\&|OF|LabSystem|OP|| ||MFN^M11|2107|2.5||| NLD|8859/1|NL| MFI|OMD|OF_OMD_NL_ |REP|||ER| MFE|MAD|1849||1849^CLEA/Creatinine clearance^L|CE OM1|1|1849^CLEA/Creatinine clearance^L|NM|Y|K231^Klinisch Chemisch Laboratorium^?|||Creatinine clearance||||||||||C| OM6|1|(CREAUV * HOEV) / (CREASE * 1440) OM2|1|ml/min|4.0||

Feb. 9, 2005IHE Educational Meeting 22 Thank you for your attention…