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March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM) Release 1 & HL7 V2.5.1 Implementation Guide: Orders and Observations; Ambulatory Care Lab Result (ELINCS) Release 1

March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

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Page 1: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

March 7, 2011

COMPARATIVE ANALYSIS

HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR

(US REALM) Release 1&

HL7 V2.5.1 Implementation Guide: Orders and Observations; Ambulatory Care Lab Result (ELINCS) Release 1

Page 2: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Purpose

• Conducted analysis of two prevalent ambulatory lab reporting implementation guides, based upon the following criteria:– Element Name– Cardinality– Usage– Length (LEN)– Data Type (DT)

• Presented assessment that utilizes existing data in each document and displays the current scenario without injecting any future outcomes

• Examined accepted data and requirements in the two implementation specifications with the following segments identified:

– Message Headers Segment (MSH)– Acknowledgment Segment (MSA)– Error Segment (ERR)– Patient Identification Segment (PID)– Patient Visit Information (PV1)– Patient Visit-Additional Information (PV2)– Common Order Segment (ORC)– Observation Request Segment (OBR)– Timing /Quantity Segment (TQ1)– Observation/Result Segment (OBX)– Specimen Segment (SPM)

Page 3: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Data Analysis Methodology

Page 4: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Background: Implementation Guides’ Context

Interoperable Laboratory Result Reporting to EHR (US Realm) Release One

• The Health Level Seven response to a request from HITSP for a standard laboratory message to meet the requirements of its use case.

• Purpose of document:– Contain specs for clinical laboratory

results reporting to EHR’s– Address messaging content and

dynamics related to AHIC• Audience:

- Analysts & Developers• Scope

- Focus on key points of broad interoperability

- Does not address laboratory order

Ambulatory Care Lab Result (ELINCS) Release 1

• Initially developed by the California HealthCare Foundation (ELINCS), this specification standardizes the transmission of electronic results from LIS to EMR in ambulatory setting.

• Purpose of document:– Provide an applicable ambulatory care

lab-reporting specification that can be adopted as a US industry standard

• Audience:– Ambulatory Care Laboratories,

Ambulatory Care Physicians, other groups or agencies that employ an EHR interface

• Scope– Focuses exclusively on the electronic

reporting of ambulatory care lab results in the US Realm.

Page 5: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Analysis Summary

• Majority of discrepancies occurred between usage of segment fields (data that is accepted v. required

• Element name is identified differently across specifications

• Data type also indicates high levels of variance

Page 6: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Element Name

HL7 Definition:• The name of element is specified by HL7

2.5.1. This name is for references and does not appear in the message data.

Analysis Findings:• The two HL7 documents had 222 differences

in using Element Names. This includes segments that were available in one document, yet lacking in the other.

• 106 Element Names matched between HL7 2.5.1 and (ELINCS) Release 1

Page 7: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Cardinality

HL7 Definition:•Cardinality defines the number of instances of a segment allowed in the message type.

[0..0] Element never present. [0..1] Element may be omitted and can have, at most, one occurrence. [1..1] Element must have exactly one occurrence. [0..n] Element may be omitted or may repeat up to n times. [1..n] Element must appear at least once, and may repeat up to n times. [0..*] Element may be omitted or repeat an unlimited number of times. [1..*] Element must appear at least once, and may repeat unlimited number of times. [m..n] Element must appear at least m, and at most, n times.

Analysis Findings:•The two HL7 documents had 93 Cardinality differences. This includes segments that were available in one document, yet lacking in the other.•235 Cardinalities matched between HL7 2.5.1 and (ELINCS) Release 1

Page 8: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Usage

HL7 Definition: •Usage indicates if a segment is required, optional, or conditional in a message.

RE – Required, but can be empty. C – Conditional. Must be populated based on computable Conditionality Statement. CE – Conditional, but can be empty. X – Not used.

O – Optional.

Analysis Findings:•The two HL7 documents had 253 Usage differences. This includes segments that were available in one document, yet lacking in the other.•The ELINCs implementation guide more tightly constrained its accepted data elements and accepted less than the HL7 2.5.1.•71 Usages matched between HL7 2.5.1 and (ELINCS) Release 1

Page 9: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Length

HL7 Definition:•Lengths display the maximum length of an element. Lengths are provided for atomic data types.

Analysis Findings:•Length has the largest variance of any section between HL7 2.5.1 and (ELINCS) Release 1•The two HL7 documents had 308 Length differences. This includes segments that were available in one document, yet lacking in the other.•20 Lengths matched between HL7 2.5.1 and (ELINCS) Release 1

Page 10: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Data Type

Example Data Types:

Data Type Data Type Name

CE Coded Element

DT Date

Analysis Findings:• The two HL7 documents had 149 Data Type

differences. This includes segments that were available in one document, yet lacking in the other.

• 179 Data Types matched between HL7 2.5.1 and (ELINCS) Release 1

• The second highest similarity from all the sections

Page 11: March 7, 2011 COMPARATIVE ANALYSIS HL7 V2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR (US REALM)

Analysis Summary and Conclusions

INTEROPERABLE LABORATORY RESULT REPORTING TO EHR (US REALM) RELEASE 1

AMBULATORY CARE LAB RESULT (ELINCS) RELEASE 1

The Health Level Seven response to a request from HITSP for a standard laboratory message to meet the requirements of its use case

Initially developed by the California HealthCare Foundation (ELINCS), this specification standardizes the transmission of electronic results from LIS to EMR in ambulatory setting.

Each section has variance in data:•Element Name•Cardinality•Usage•Length (LEN)•Data Type (DT)

Each section has variance in data:•Element Name•Cardinality•Usage•Length (LEN)•Data Type (DT)

Includes the following segments:•Patient Visit Information (PV1) Segment•Patient Visit-Additional Information (PV2)

Excludes the following segments:•Patient Visit Information (PV1) Segment•Patient Visit-Additional Information (PV2)

Intended Audience:•Analysts & Developers

Intended Audience:•Ambulatory Care Laboratories, Ambulatory Care Physicians, other groups or agencies that employ an EHR interface