1. Integrating the Healthcare Enterprise Laboratory Technical Framework New Integration Profiles Francois Macary GWI Medica France - Agfa Healthcare IT Cochair IHE Laboratory Committee IHE Interoperability Workshop

2. Laboratory IHE Integration Profiles Laboratory Scheduled Workflow (LSWF) Connectathon 2004, 2005 Laboratory Device Automation (LDA) Laboratory Information Reconciliation (LIR) Laboratory Point Of Care Testing (LPOCT) Laboratory Code Set Distribution (LCSD) IHE Interoperability Workshop

3. Laboratory Device Automation (LDA) Work Order Steps LDA Demographics Demographics ADT Clinical Laboratory Placer order Order Placer Order Filler Filler order Work order Results Results Order Result Tracker Automation Manager LSWF IHE Interoperability Workshop

4. Example of workflow Perform electrolye Work Order for serum n° 123 Blood specimen Step 1: Convey to decapper Step 4: Query for test? Test Na, K, Cl Send the results Step 6: recap Step 2: decap centrifuging Step 5: Convey to recapper Step 3: Convey to chemistry analyzer Serum Schedules steps 1 to 6 Downloads steps 1, 2, 3, 5, 6 Automation Manager Chemistry Analyzer decapper recapper Robotic Specimen Transportation System IHE Interoperability Workshop

5. Laboratory IHE Integration Profiles Laboratory Scheduled Workflow (LSWF) Connectathon 2004, 2005 Laboratory Device Automation (LDA) Laboratory Information Reconciliation (LIR) Laboratory Point Of Care Testing (LPOCT) Laboratory Code Set Distribution (LCSD) IHE Interoperability Workshop

6. Laboratory Point Of Care Testing • Tests of clinical biology, performed on point of care or patient bedside • In vitro tests: performed on a specimen, not on the patient itself • Usually quick tests, specimen collected, tested at once and eliminated • No pre or post-processing (like in LDA) • Results used immediately by the care provider in its clinical decisions • Supervision by a clinical laboratory of the healthcase enterprise • Training provided to the ward staff  good practices on specimen and analyzer • Provision of reagent • Supervision of quality control • A posteriori clinical validation IHE Interoperability Workshop

7. Contraints and benefits of point of care testing • Results obtained at once  increases the efficiency of clinical decisions • Minimizes the blood quantity drawn from the patient, because of the immediate use of the specimen. E.g. Two drops are enough to test blood gaz, electrolyte and hematocrit of a new-born baby. • Preserving a high level of quality of the POCT process requires its supervision by a clinical laboratory. (This is at least agreed upon in US and Europe) IHE Interoperability Workshop

8. Examples of LPOCT devices • Portable blood gaz and chemistry analyzer used by the nurse on patient bedside • Blood gaz analyzer permanently installed in a surgery theater • Coagulation analyzer in acute care ward • Glucometer used by the patient in home care • Work station on which the nurse manually enters the results of pregnancy stick tests. IHE Interoperability Workshop

9. Laboratory IHE Integration Profiles Laboratory Scheduled Workflow (LSWF) Connectathon 2004, 2005 Laboratory Device Automation (LDA) Laboratory Code Set Distribution (LCSD) Laboratory Information Reconciliation (LIR) Laboratory Point Of Care Testing (LPOCT) IHE Interoperability Workshop

10. Laboratory Code Set Distribution Order Filler Enterprise Common Repository … Laboratory Code Set Master LAB-51: Laboratory Code Set Management Laboratory Code Set Consumer Order Placer Order Result Tracker Automation Manager Order Filler … Chosen standard: HL7 V2.5, Master Files (chapter 8) IHE Interoperability Workshop

11. Laboratory IHE Integration Profiles Laboratory Information Reconciliation (LIR) Laboratory Scheduled Workflow (LSWF) Connectathon 2004, 2005 Laboratory Device Automation (LDA) Laboratory Point Of Care Testing (LPOCT) Laboratory Code Set Distribution (LCSD) IHE Interoperability Workshop

12. Laboratory Information Reconciliation • Match clinical lab observations produced on specimens collected from misidentified or unidentified patient with the patient’s record. • Match clinical lab observations produced on specimens with orders created afterwards, either in the Order Placer or in the Order Filler application. IHE Interoperability Workshop

13. Other extensions • Upload Quality Control Results from analyzers to Order Filler (via Automation Manager) • extension of LSWF profile • Publish lab reports in clinical electronic documents • LIS in the role of Document Source in XDS profile IHE Interoperability Workshop

14. Schedule • Face to face meeting in May (date to adjust) • Public comment version end of May • Trial Implementation version 2.0 end of June • Thank you for your attention… IHE Interoperability Workshop