Lab Public Health Reporting Content
Introduction
This is a draft of the Lab Public Health Reporting Content Profile supplement to the Patient Care Coordination Technical Framework. This draft is a work in progress, not the official supplement or profile.
Motivation
The motivation for developing this profile is as follows:
- Show that the same standards that support the current IHE profiles for clinical care interoperability can be leveraged by population health.
- Encourage the public health community to come forward to IHE with use cases to further enhance data sharing.
Profile Abstract
NOTE: we are working with HITSP/PHDSC to refine this definition
Our goal with this profile is to adapt XDS-LAB integration content profile to accommodate data for a public health laboratory report. Modifications to XDS-LAB will be needed to accommodate non-human subjects, document participants in the laboratory testing process, and to group tests for a reportable condition in a consistent manner. Leveraging the CDA R2 standard and the XDS-LAB profile make the resultant document not only consumable by public health, but able to be sent back to the clinical care provider and even possible to include into an effected patient’s medical record thereby completing a communication loop between private and public population care.
Glossary
- no terms, yet
Volume I
Introduction
Profile Dependencies
- XD*
- XDS-Lab
Profile Name
The Lab Public Health Reporting integration content profile adapts XDS-Lab to accommodate data for a public health laboratory report. Modifications to XDS-LAB will be needed to accommodate non-human subjects, document participants in the laboratory testing process, and to group tests for a reportable condition in a consistent manner. Leveraging the CDA R2 standard and the XDS-LAB profile make the resultant document not only consumable by public health, but able to be sent back to the clinical care provider and even possible to include into an effected patient’s medical record there upon effectively closing the communication loop between individual and population care.
Use Cases
NOTE: we are working with HITSP/PHDSC to refine this use case
John Doe, MD sees a patient and suspects that this patient has an enteric pathogen. The patient follows through on the doctor’s orders and submits a specimen to the clinic lab. Upon completion of laboratory analysis, the lab confirms the presence of Salmonella. At the end of the week, the microbiology lab reviews the log book and gathers all the reportable results and enters them into a spreadsheet for submission to the state public health lab. Additionally, the clinic laboratory does not have the necessary reagents to serotype the Salmonella isolate. This specimen is mailed along with a hand written requisition to the state lab for further analysis to determine the serotype.
The state laboratory identifies it as an uncommon strain of Salmonella and has a procedure for alerting others to help identify the source. Within days a state epidemiologist receives a paper result report and notifies by phone, fax, and email the relevant state, county, and local programs. At the end of the week, the state lab reports the Salmonella isolate to the national CDC program and PulseNet.
The national CDC program soon recognizes cases across state borders and generates appropriate notification and oversight.
To this point in the scenario, three or more weeks have elapsed since the patient first visited the local clinic. The documentation for this outbreak is spread over several levels of oversight which do not have access to each other’s information, nor are they able to receive immediate electronic notification of developments.
After this profile is adopted: The reportable laboratory result is submitted to public health authorities electronically at the same time the Salmonella result is released to the care providers. The state laboratory’s expected queue is automatically updated ensuring that when the specimen arrives little data entry is required to receive the specimen for serotyping. Further, at the release of the serotype from the state, the laboratory electronically generates a CDA document that is shared with appropriate public health agencies. The only time delay is that which is required for performing the necessary testing.
Actors/Transaction
There two actors in this profile: Content Creator and a Content Consumer.
Actor Definitions
- Content Consumer
- A content consumer makes use of data contained in.
- Content Creator
- A content creator assembles the data for and produces the document described in
the integration content profile.
Transaction Definitions
To be defined, we await a common content profile template for HL7 CDA R2 based content profiles.
Volume II
Referenced Standards
Document Specifications
Please see the following PDF: ContentProfileForPublicHealthReport.pdf
Open Issues
- Still need to discuss the best way to accomodate a non-human living subject in a CDA.
- What of the proposed here should be fed back to XDS-Lab in the form of CPs?
- How to include attachments (such as images)?
- Do we support the concept of "global specimen id" in the XDS metadata? Can it be queried? For Example: "Find me all documents related to this specimen".