1. What IHE Delivers 1 IHE Netherlands Lab Working Group Update Alexander Henket May 15, 2009 - Kyoto

2. 2 Background IHE-Lab start December 2007 “Joint” initiative between IHE Netherlands and NICTIZ Goal  Define use-cases for national exchange of lab- information  Define interoperability specification taking Dutch Healthcare Infrastructure into account

3. 3 Methodology Phase I (done)  “User driven”  Defining “use-cases” Phase 2 (in progress)  “Defining technical details” Data format and transport protocol Data format and transport protocol Phase 3  Proof-of-concept

4. 4 Phase 1: Selecting Use-cases

5. 5 Fase 2 (In Progress) Technical deep-dive on use-cases Define and review (technical) interactions between actors including the Dutch Healthcare infrastructure (AORTA) Investigate use of HL7 v3 CDA Define a CDA template for a lab-order.

6. 6 Technical deep-dive GP Lab External Phlebotomy station Internal

7. 7 Technical Deep-dive Analogy with Document based Referral Request Profile

8. 8 Interaction Dutch AORTA AORTA

9. 9 Interaction Dutch AORTA (2)

10. 10 Use of HL7v3 CDA Main debate  Should the “lab referral” be a document or a message?  Focus on key set of select criteria (persistence, ownership, signature, readability, etc.) Conclusion  Order should be an electronic document  Main criteria: persistence, readability  Lab results should also be an electronic document to stay consistent (less clear for Clin. Chemistry)

11. 11 Defining CDA Template Available standards  NTA 7508 (Dutch NEN standard defining an edifact lab order and result set)  IHE-Lab, vol 3  HL7 v3 Lab Model To be continued…..

12. 12 WWW.IHE-NL.ORG

13. Use Cases standard community order order discontinued by laboratory order canceled by specimen collection center order modified by order placer 13

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16. Actors Order Tracer will also send out notifications to the Order Placer upon discontinuation or cancellation: is that extending the actor? 16

17. Transactions Specimen reports will have an append relationship to the order. How do we handle Result/Order relationship when we cannot link at document level? inFulFillmentOf will link to the order, but the order it references cannot be the CDA document that contained the order. Instead it will reference into the CDA Body of another document. Preadopt CDA Release 3 17

18. Transactions cont’d: status Use RCMR messages only, or is Shared Messages/ActStatus topic viable? Document Status changes in RCMR go to Document Recipient which does not fit requirements Should there be more statuses than: ordered, accepted, in progress, completed, e.g. specimen received? Can another party than the author /custodian of a document change the status of a document? 18

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