Laboratory Point Of Care Testing

Laboratory Point Of Care Testing LPOCT) covers in vitro diagnostic tests performed on the point of care in a healthcare institution.

Summary

The Laboratory Point Of Care Testing Profile covers the workflow related to in vitro diagnostic tests performed on the point of care or on patient bedside by caregivers in the clinical wards of the healthcare institution, this process being supervised by a laboratory of the institution. This supervision includes clinical validation of POC results, Quality Control (QC) surveillance, point of care devices surveillance, reagent delivery, and education on good testing practices delivered to the ward staff. The point of care testing devices operated by physicians and nurses are connected to and controlled by a central Point Of Care Data Manager. This POC Data Manager is connected to the LIS of the laboratory for consolidation of the point of care testing results, and to the HIS of the institution, which provides up to date patient data.
The main characteristics of point of care testing are:

Specimen drawn from the patient by the caregiver, tested immediately, and then eliminated. (no pre or post-processing of the specimen).
The results are produced and displayed at once on the point of care device, and can be used immediately in the caregiver's clinical decisions.

The main value proposition of this profile is the securization of the workflow by a real-time patient identity checking and the consolidation of point of care orders and their observations in the enterprise-wide repository of orders and observations.

Benefits

Reduces Errors and Enhance Patient Care

For POC devices persistently connected, the real time patient identity checking secures the process:

The caregiver scans or enters manually a patient ID or encounter ID on the device, together with contextual information (device id, staff id, tests to be performed...)
The device queries the POC data manager and obtains in the response the patient identity as it is registered in the HIS, and displays the patient name.

POC testing devices usually require a minimal quantity of blood to operate. No transportation, no delay, hence no pre-processing of the specimen. Thus POC testing minimizes blood drawing from the patient, which makes this process particularly accurate in pediatric and neo-natology wards.
Accelerates the diagnostic, thus the treatment, in all situations where simple chemistry or hematology tests is critical to set the proper diagnostic or choose the best immediate action. Point of care testing is for this reason usefull in emergency departments, intensive care units, and operating theaters.
Consolidates point of care testing observation in the common repository of orders and observations, thus keeping available for further historic access by caregivers, point of care observations together with laboratories test results.

Favors independence of healthcare institution from their clinical and ancillary systems and devices

By providing clear specifications of interfaces between point of care devices, data manager and LIS, this Integration Profile enables the healthcare insitution to replace one of these systems without breaking the existing data workflows.

Details

The Laboratory Testing Workflow (LTW) Integration Profile establishes the continuity and integrity of in vitro diagnostic test orders placed towards clinical laboratories for a patient, and of the results produced for these orders, inside the healthcare institution.
This Integration Profile is bound to in vitro diagnostic testing (tests performed on in vitro specimen). It supports all laboratory specialties but anatomic pathology.
The LTW Integration Profile covers three major use cases:

Order placed with specimens collected and identified by the orderer
Order placed with specimens collected by a third party, then identified and labeled by the laboratory information system
Order generated by the laboratory and notified to the ordering system to obtain an order number.

LTW Integration Profile defines 5 Transactions, all of which based on HL7 release 2.5 or 2.5.1 messaging standard. Each transaction selects a subset of HL7 message structures (based on OML, ORL, ORU and OUL) and specifies a set of constraints applying to each message structure, as well as the responsibilities of the sender and receiver.

Systems Affected

Systems involved in this profile are:

One or more Clinical Information Systems (CIS). Each of these systems is operated by a clinical facility and provides a number of features such as order entry, order placing, placer order management and follow-up, order result tracking, management of patient biologic history, specimen calculation, specimen identification... A CIS usually implements the Actors Order Placer and Order Result Tracker.
One or more Laboratory Information Systems (LIS). Each of these systems is operated by a number of clinical laboratories inside the institution. The LIS offers features such as order reception, specimen calculation, specimen identification or specimen acceptance, order check, scheduling, filler order management, production of worklists, result manual entry for non connected-tests, clinical validation and interpretation of results, result reporting. Each LIS implements an Order Filler Actor.
One or more Laboratory Automation Systems (LAS) operated in each laboratory. A LAS manages a set of automated laboratory devices (pre-analytical devices, analyzers, post-analytical devices). The LAS receives Work Orders related to a specimen and processes the various steps of a WSork Order on its set of devices, to eventually get the test results, perform the technical validation thereof, and upload them back to the LIS.

A laboratory request ordered by a physician for a patient is frequently composed of multiple tests and panels placed to a laboratory. Such a laboratory request containing several orders is called an Order Group in the HL7 standard, and uniquely identified by the ordering CIS with a Placer Group Number. Each of the orders is in turn uniquely identified by the CIS with a Placer Order Number. Each order accepted by the laboratory as well as each reflex order generated by the laboratory is uniquely identified by the LIS with a Filler Order Number.

Actors & Transactions:

File:Lpoct-actor-transaction.JPG

Other requirements for systems implementing LTW (dependencies towards IT Infrastructure Profiles):

An application implementing one of the Actors Order Placer, Order Result Tracker, Order Filler shall also implement the Actors Patient Demographics Consumer and Patient Encounter Consumer from either PAM or PDQ Profile or both.
An application implementing one of the Actors Order Placer, Order Result Tracker, Order Filler shall also implement the Actor Secure Node from the ATNA Profile, as well as the Actor Time Client from the CT Profile.

Specification

Profile Status: Trial Implementation

Documents:

IHE Laboratory Technical Framework:

Underlying Standards:

Laboratory Point Of Care Testing

Contents

Summary

Benefits

Details

Systems Affected

Specification

See Also

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