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LRI Validation Suite Meeting
September 06, 2011
Agenda• Test data update
– Selection of core message set• Update • Review validation discussion page
– Mapping lab results and LOINC• Review of EHR Test Plan Template• Update on LIS Test Plan Template• Face-to-Face Questionnaire• NIST/LMCO meeting• Tooling• Juror Document/Spreadsheet Analysis
– Identify other MU requirements we can leverage (e.g., usability)– Mapping CLIA requirements to HL7 Elements– Identifying Reportable Conditions to PH Lab Results
• Planning
Categorization of Tests
• The 144 individual tests in the final version of the list can be clinically organized into six clinical lab test categories. These are:
1)Common Hematology tests (16), 2)Urinalysis test (1),3)Common Chemistry tests (34), 4)Special Chemistry tests (27), 5)Microbiology tests (50), plus antibiotic susceptibility tests (7), and 6)Other Clinical Lab tests (9).
20 Common Tests
1. CBC and WBC Differential/Morphology,2. Urinalysis, and3. Comprehensive Metabolic Panel (CMP)– Quest Diagnostics Directory of Services and Specimen
Collection Guide of May, 2008 the CMP included 17 items: – Calcium; BUN; Creatinine; BUN/Creatinine Ratio (a calculated
value); Total Protein; Albumin; Globulin; Albumin/Globulin Ratio (a calculated value); Bilirubin, Total; Glucose; Alkaline Phosphatase; AST; ALT; Sodium; Potassium; Chloride; CO2.
LOINC-RELMA List for HemoglobinLOINC # Component Property Time Aspect System Scale Ex. UCUM Units Ex. Units Class
Long Common Name Order/Obs Type11559-2 Oxyhemoglobin/Hemoglobin.total MFr Pt Bld Qn % % CHEM Fractional
oxyhemoglobin in Blood Observation 119949-7 Oxyhemoglobin/Hemoglobin.total MFr 8H^max BldA Qn % % PULM Fractional
oxyhemoglobin in 8 hour maximum Arterial blood 219951-3 Oxyhemoglobin/Hemoglobin.total MFr 8H^min BldA Qn % % PULM Fractional
oxyhemoglobin in 8 hour minimum Arterial blood 219953-9 Oxyhemoglobin/Hemoglobin.total MFr Pt Bld.preductal Qn % % PULM Fractional
oxyhemoglobin in Blood Preductal 219955-4 Oxyhemoglobin/Hemoglobin.total MFr Pt Bld.postductal Qn % % PULM Fractional
oxyhemoglobin in Blood Postductal 22714-4 Oxyhemoglobin/Hemoglobin.total MFr Pt BldA Qn % % CHEM Fractional
oxyhemoglobin in Arterial blood Observation 12715-1 Oxyhemoglobin/Hemoglobin.total MFr Pt BldC Qn % % CHEM Fractional
oxyhemoglobin in Capillary blood Observation 12716-9 Oxyhemoglobin/Hemoglobin.total MFr Pt BldV Qn % % CHEM Fractional
oxyhemoglobin in Venous blood Observation 12717-7 Oxyhemoglobin/Hemoglobin.total MFr Pt Plas Qn % % CHEM Fractional
oxyhemoglobin in Plasma Observation 130369-3 Oxyhemoglobin/Hemoglobin.total MFr Pt BldCoV Qn % % of tot CHEM
Fractional oxyhemoglobin in Venous cord blood Observation 130370-1 Oxyhemoglobin/Hemoglobin.total MFr Pt BldCoA Qn % % of tot CHEM
Fractional oxyhemoglobin in Arterial cord blood Observation 134969-6 Oxyhemoglobin/Hemoglobin.total MFr Pt BldMV Qn % % of tot CHEM
Fractional oxyhemoglobin in Mixed venous blood Observation 1 No Method listed in RELMA for any of these tests
Testing Options/PolicyLOINC # Component Property Time Aspect System Scale Ex. UCUM Units Ex. Units Class Long Common Name Order/ObsType11559-2Oxyhemoglobin/Hemoglobin.total MFr Pt Bld Qn % % CHEM Fractional oxyhemoglobin in Blood Observation 119949-7Oxyhemoglobin/Hemoglobin.total MFr 8H^max BldA Qn % % PULM Fractional oxyhemoglobin in 8 hour maximum Arterial blood 219951-3Oxyhemoglobin/Hemoglobin.total MFr 8H^min BldA Qn % % PULM Fractional oxyhemoglobin in 8 hour minimum Arterial blood 2
OBR|1|111325^EHR^2.16.840.1.113883.19.3.2.3^ISO|1132896^Lab^2.16.840.1.113883.19.3.1.6^ISO|718-7^Hemoglobin^LN|||20070701152505|||||||||100^Hippocrates^Harold||||||20070701162505||CH|F|NA&Not Applicable&LB
OBX|1|NM|11559-2^Hemoglobin.Total^LN||^12.4|g/dL^grams per deciliter^UCUM|12.0 to 16.0||||F|||20070701152505|||||||||Effective Labs, Inc^^^^^DRSD&2.16.840.1.113883.19.1.11&ISO^XX^^^6543|3434 Test Loop^^Ann Arbor^MI^48103^^B
• Depending on what the order is, what are possible test results? Are there more than one valid test result base on local conventions, etc.?
• Potential Test Case Policy: In the data sheet (test case) we can allow any of these to be selected. This assumes that nothing else in the message needs to be changed. It would be an easy way to provide the capability to tests all of these LOINC codes with minimal effort. The Long Common Name is the differentiator.
• One of the determining factors likely will be whether or not the same result value can be used for all of the various versions of Oxyhemoglobin/Hemoglobin.total.
Issues/Comments:• Other data elements in the HL7 message might also need to be test-specific. For example, if data for the SPM-4: Specimen
Type and SPM-8: Specimen Source are included in the message, then the same message probably could not be used for all of the versions of Oxyhemoglobin/Hemoglobin.total. OBX-7: Reference Range also might be a limiting factor if venous blood and arterial blood result values have normal ranges that don’t overlap.
• The LOINC code is the anchor that discretely and accurately identifies the lab test that was ordered/performed. No matter what a hospital or physician chooses to call the test, the LOINC code is the one constant that tells everyone which it test was. For our purposes, we’ll need to be sure that all of the data for the data elements in the HL7 message are appropriate for the test indicated by the LOINC code.
Reporting Format Requirement1. Tests and/or components with numeric results, units, and normal ranges
2. Tests and/or components with a limited set of textual results with or without normal ranges
1. positive/negative/indeterminate, resistant/intermediate/susceptibility2. cytology / anatomic pathology3. mutation type and location4. organism name
3. Tests with defined structure in Observation Result Segment OBX-3 through OBX-8 for the reporting of Culture Results and Antimicrobial Sensitivities
4. Semi Structured or Unstructured components or results Tests and/or components reported in a PDF or data blob
1. The 4th reporting format may be utilized in the cases where structured data does not apply (e.g. images).
Note on the use of LOINC
• The list of tests has been organized by order panel or, for micro related tests, by target organism for easier readability.
• The LOINC terms included here are considered examples only – though they may be the more common LOINC terms, each laboratory needs to be sure to map their own tests to the most appropriate LOINC, even if it is NOT on this list.
• This is NOT an exclusive list of LOINC terms – ANY valid LOINC should be accepted in data exchange projects based on this specification.
Action List: Initial Set of Test Data• Select at least one test from first 5 clinical test categories
– Category 6 is “others”• Include:– CBC and WBC Differential/Morphology, (2 results)– Urinalysis, and (1 result)– Comprehensive Metabolic Panel (CMP) (17 Results)
• Include test to cover the 4 (3 ??) reporting formats– However, the second format is not in the test list
• Create coverage mapping table of tests/LOINC codes– Results (1 to many LOINC codes—how do we handle, document?)
• Get sample messages– Example from IG– NIST Related set of test data– Messages to be verified
• Finish test case for one simple message
Examples From IG• LEAD LABORATORY RESULT MESSAGE• CAMPYLOBACTER JEJUNI• ANIMAL RABIES• HEPATITIS C VIRUS• Example: Minimal Message• Culture Results– stool culture – Three pathogens: Campylobacter jejuni, Salmonella
and Shigella. • Examples of Culture and Susceptibility Results• LINKING PARENT AND CHILD RESULTS
LEAD LABORATORY RESULT MESSAGEMSH|^~\&|Lab1^1234^CLIA|^1234^CLIA|ELR^2.16.840.1.113883.19.3.2^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|20080818183002.1-0700||
ORU^R01^ORU_R01|1234567890|P^T|2.5.1|||NE|NE|USA||||USELR1.0^^2.16.840.1.114222.4.10.3^ISOSFT|1|Level Seven Healthcare Software, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|1.2|An Lab System|56734||20080817PID|1||
36363636^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MR^A&2.16.840.1.113883.19.3.2.1&ISO~444333333^^^&2.16.840.1.113883.4.1^ISO^SS||Everyman^Adam^A^^^^L^^^^^^^BS|Mum^Martha^M^^^^M|20050602|M||2106-3^White^CDCREC^^^^04/24/2007|2222 Home Street^^Ann Arbor^MI^99999^USA^H||^PRN^PH^^1^555^5552004|^WPN^PH^^1^955^5551009|eng^English^ISO6392^^^^3/29/2007|M^Married^HL70002^^^^2.5.1||||||N^Not Hispanic or Latino^HL70189^^^^2.5.1||||||||N|||200808151000-0700|Reliable^2.16.840.1.113883.19.3.1^ISO
NK1|1|Mum^Martha^M^^^^L|MTH^Mother^HL70063^^^^2.5.1| 444 Home Street^Apt B^Ann Arbor^MI^99999^USA^H|^PRN^PH^^1^555^5552006
PV1|1|O|4E^234^A^Good Health Hospital&2.16.840.1.113883.19.3.2.3&ISO^N^N^Building 1^4^Nursing unit 4 East^1234&&2.16.840.1.113883.19.3.2.3&ISO^&2.16.840.1.113883.19.3.2.3&ISO|R||||||||||||||||||||||||||||||||||||||||200808151000-0700|200808151200-0700
PV2|||1^Sick^99AdmitReason|||||||||||||N||||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|||20010603|||19990603ORC|RE|23456^EHR^2.16.840.1.113883.19.3.2.3^ISO|9700123^Lab^2.16.840.1.113883.19.3.1.6^ISO|||||||||1234^Admit^Alan^A^III^Dr^^^&2.16.840.1.113883.19.4.6^ISO^L^^^EI^&2.16.840.1.113883.19.4.6^ISO^^^^^^^^MD||^WPN^PH^^1^555^5551005|||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|1005 Healthcare Drive^^Ann Arbor^MI^99999^USA^B|^WPN^PH^^1^555^5553001|4444 Healthcare Drive^Suite 123^Ann Arbor^MI^99999^USA^B
OBR|1|23456^EHR^2.16.840.1.113883.19.3.2.3^ISO|9700123^Lab^2.16.840.1.113883.19.3.1.6^ISO|10368-9^Lead BldC-mCnc^LN^3456543^Blood lead test^99USI^2.24|||200808151030-0700||||||diarrhea|||1234^Admit^Alan^A^III^Dr^^^&2.16.840.1.113883.19.4.6^ISO^L^^^EI^&2.16.840.1.113883.19.4.6^ISO^^^^^^^^MD|^WPN^PH^^1^555^5551005|||||2008081830-0700|||F||||||787.91^ DIARRHEA^I9CDX^^^^07/09/2008|1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO
OBX|1|NM|10368-9^Lead BldC-mCnc^LN^^^^2.24|1|50|ug/dL^micro-gram per deci-liter^UCUM^^^^1.6|<10 ug/dL|H|||F|||200808151030-0700|||||200808181800-0700||||Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^^Ann Arbor^MI^99999^USA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI
SPM|1|23456&EHR&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO||122554006^Capillary blood specimen^SCT^BLDC^Blood capillary^HL70070^20080131^2.5.1||HEPA^Ammonium heparin^HL70371^^^^2.5.1|CAP^Capillary Specimen^HL70488^^^^2.5.1|181395001^Venous structure of digit^SCT^^^^20080731|||P^Patient^HL60369^^^^2.5.1|50^uL&MicroLiter&UCUM&&&&1.6|||||200808151030-0700|200808151100-0700
OBX|2|NM|35659-2^Age at specimen collection^LN^^^^2.24||3|a^year^UCUM^^^^1.6|||||F|||200808151030-0700|||||200808151030-0700||||Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^^Ann Arbor^MI^99999^USA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI
CAMPYLOBACTER JEJUNIMSH|^~\&|Lab1^1234^CLIA|^1234^CLIA|ELR^2.16.840.1.113883.19.3.2^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|20080818183002.1-
0700||ORU^R01^ORU_R01|1234567890|P^T|2.5.1|||NE|NE|USA||||USELR1.0^^2.16.840.1.114222.4.10.3^ISOSFT|1|Level Seven Healthcare Software, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|1.2|An Lab System|56734||20080817PID|1||
36363636^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MR^A&2.16.840.1.113883.19.3.2.1&ISO~444333333^^^&2.16.840.1.113883.4.1^ISO^SS||Everyman^Adam^A^^^^L^^^^^^^BS|Mum^Martha^M^^^^M|19800602|M||2106-3^White^CDCREC^^^^04/24/2007|2222 Home Street^^Ann Arbor^MI^99999^USA^H||^PRN^PH^^1^555^5552004|^WPN^PH^^1^955^5551009|eng^English^ISO6392^^^^3/29/2007|M^Married^HL70002^^^^2.5.1||||||N^Not Hispanic or Latino^HL70189^^^^2.5.1||||||||N|||200808151000-0700| Reliable^2.16.840.1.113883.19.3.1^ISO
PV1|1|O|4E^234^A^Good Health Hospital&2.16.840.1.113883.19.3.2.3&ISO^N^N^Building 1^4^Nursing unit 4 East^1234&&2.16.840.1.113883.19.3.2.3&ISO^&2.16.840.1.113883.19.3.2.3&ISO|R||||||||||||||||||||||||||||||||||||||||200808151000-0700|200808151200-0700
PV2|||1^Sick^99AdmitReason|||||||||||||N||||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|||20010603|||19990603
ORC|RE|23456^EHR^2.16.840.1.113883.19.3.2.3^ISO|9700123^Lab^2.16.840.1.113883.19.3.1.6^ISO|||||||||1234^Admit^Alan^A^III^Dr^^^&2.16.840.1.113883.19.4.6^ISO^L^^^EI^&2.16.840.1.113883.19.4.6^ISO^^^^^^^^MD||^WPN^PH^^1^555^5551005|||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|1005 Healthcare Drive^^Ann Arbor^MI^99999^USA^B|^WPN^PH^^1^555^5553001|4444 Healthcare Drive^Suite 123^Ann Arbor^MI^99999^USA^B
OBR|1|23456^EHR^2.16.840.1.113883.19.3.2.3^ISO|9700123^Lab^2.16.840.1.113883.19.3.1.6^ISO|625-4^Bacteria identified^LN^3456543^ CULTURE, STOOL^99USI^2.26|||200808151030-0700||||||diarrhea|||1234^Admit^Alan^A^III^Dr^^^&2.16.840.1.113883.19.4.6^ISO^L^^^EI^&2.16.840.1.113883.19.4.6^ISO^^^^^^^^MD|^WPN^PH^^1^555^5551005|||||2008081830-0700|||F||||||787.91^ DIARRHEA^I9CDX^^^^07/09/2008|1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO
OBX|1|CWE|625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN^^^^2.26|1|66543000^Campylobacter jejuni^SCT^^^^January 2007||||||P|||200906041458|||0086^Bacterial identification^OBSMETHOD^^^^501-20080815||200906051700||||GHH Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^^Ann Arbor^MI^99999^USA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI
SPM|1|23456&EHR&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO||119339001^Stool specimen^SCT^^^^20080131|||||||P^Patient^HL60369^^^^2.5.1|10^g&gram&UCUM&&&&1.6|||||200808151030-0700|200808151100-0700
Example: Minimal MessageMSH|^~\&|Lab1^1234^CLIA|^1234^CLIA|ELR^2.16.840.1.113883.19.3.2^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|20080818183002.1-
0700||ORU^R01^ORU_R01|1234567890|P^T|2.5.1|||NE|NE|USA||||USELR1.0^^2.16.840.1.114222.4.10.3^ISOSFT|1|Level Seven Healthcare Software, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|1.2|An Lab System|56734||20080817PID|1||
36363636^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MR^A&2.16.840.1.113883.19.3.2.1&ISO~444333333^^^&2.16.840.1.113883.4.1^ISO^SS||Everyman^Adam^A^^^^L^^^^^^^BS|Mum^Martha^M^^^^M|20050602|M||2106-3^White^CDCREC^^^^04/24/2007|2222 Home Street^^Ann Arbor^MI^99999^USA^H||^PRN^PH^^1^555^5552004|^WPN^PH^^1^955^5551009|eng^English^ISO6392^^^^3/29/2007|M^Married^HL70002^^^^2.5.1||||||N^Not Hispanic or Latino^HL70189^^^^2.5.1||||||||N|||200808151000-0700| Reliable^2.16.840.1.113883.19.3.1^ISO
ORC|RE|23456^EHR^2.16.840.1.113883.19.3.2.3^ISO|9700123^Lab^2.16.840.1.113883.19.3.1.6^ISO|||||||||1234^Admit^Alan^A^III^Dr^^^&2.16.840.1.113883.19.4.6^ISO^L^^^EI^&2.16.840.1.113883.19.4.6^ISO^^^^^^^^MD||^WPN^PH^^1^555^5551005|||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6^ISO^XX^^^1234|1005 Healthcare Drive^^Ann Arbor^MI^99999^USA^B|^WPN^PH^^1^555^5553001|4444 Healthcare Drive^Suite 123^Ann Arbor^MI^99999^USA^B
OBR|1|23456^EHR^2.16.840.1.113883.19.3.2.3^ISO|9700123^Lab^2.16.840.1.113883.19.3.1.6^ISO|10368-9^Lead BldC-mCnc^LN^3456543^Blood lead test^99USI^2.24|||200808151030-0700||||||diarrhea|||1234^Admit^Alan^A^III^Dr^^^&2.16.840.1.113883.19.4.6^ISO^L^^^EI^&2.16.840.1.113883.19.4.6^ISO^^^^^^^^MD|^WPN^PH^^1^555^5551005|||||2008081830-0700|||F||||||787.91^DIARRHEA^I9CDX^^^^07/09/2008|1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO
OBX|1|NM|10368-9^Lead BldC-mCnc^LN^^^^2.24||50|ug/dL^micro-gram per deci-liter^UCUM^^^^1.6|<10 ug/dL|H|||F|||200808151030-0700|||||200808181800-0700||||Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^^Ann Arbor^MI^99999^USA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI
SPM|1|23456&EHR&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO||122554006^Capillary blood specimen^SCT^BLDC^Blood capillary^HL70070^20080131^2.5.1||HEPA^Ammonium heparin^HL70371^^^^2.5.1|CAP^Capillary Specimen^HL70488^^^^2.5.1|181395001^Venous structure of digit^SCT^^^^20080731|||P^Patient^HL60369^^^^2.5.1|50^uL&MicroLiter&UCUM&&&&1.6|||||200808151030-0700|200808151100-0700
