Sharing Laboratory Reports

Sharing Laboratory Reports (XD-LAB) describes the laboratory report as an electronic content to be shared among a community of healthcare settings and care providers relying on a document sharing infrastructure.

Summary

This Content Integration Profile describes a clinical laboratory report as an electronic document to be published towards a document sharing resource such as an Electronic Health Record (EHR) or in Personal Health Record (PHR) shared by a community of care providers, using one of the document sharing profiles defined in ITI-TF. Such an electronic document contains the set of releasable results produced by a clinical laboratory in fulfillment of one or more test Orders for a patient. The report is shared in a human-readable format. In addition, this electronic laboratory report SHALL contain test results in a machine-readable format, to facilitate the integration of these observations in the database of a consumer system.
The scope of this profile covers all laboratory specialties except anatomic pathology.
This profile leverages IT Infrastructure profiles [ATNA] and [CT] for security, and [XDS], [XDM], [XDR] for document sharing.
This profile leverages the [Clinical Document Architecture Release 2] (CDAr2) standard from [HL7]

Benefits

Facilitates Patient Care Coordination

Enables the caregiver to obtain at once the laboratory reports produced during previous episodes of care.
Reduce over-ordering and over blood sampling from the patient by sharing the last laboratory reports among the various physicians attending the patient.
Enables the physician to consolidate their patient biological history by importing into their EHR the structured and coded data embedded in the electronic laboratory report.

Details

The Laboratory Testing Workflow (LTW) Integration Profile establishes the continuity and integrity of 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:

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.