Lab Test Results

MU Requirements

Meaningful Use Measures:

At least 50% of all clinical lab tests ordered whose results are in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

Certification Criteria for EHR:

1. Electronically receive clinical laboratory test results in a structured format and display such results in human readable format.

2. Electronically display in human readable format any clinical laboratory tests that have been received with LOINC® codes.

3. Electronically display all the information for a test report specified at 42 CFR 493.1291(c)(1) through (7).

4. Enable a user to electronically update a patient’s record based upon received laboratory test results."

From CCHIT:

1. IO-AM 07.01 The system shall provide the ability to receive and store general laboratory results (includes ability to differentiate preliminary results and final results and the ability to process a corrected result) using the HL7 v.2.5.1 ORU message standard.

2. IO-AM 07.02 The system shall provide the ability to receive and store microbiology laboratory results with organisms recorded as free-text. (Not MU).

3. IO-AM 07.04 The system shall provide the ability to receive and store microbiology laboratory results with sensitivity testing coded using LOINC.

Proposed Solution

1. Work with Dr. Bowen to establish business relationship with Quest and Labcorp.

2. Work with Tony and Dr. Bowen to develop lab order entry and management workflows. See two proposed workflows.

Point of Care

Lab Order

3. Get data specifications and API from Quest and Labcorp.

4. Select 100 lab orders/tests from primary care and specialties.

Lab Orders Selection

5. Build an electronic catalog of lab orders in database format.

● types of tests, with id, name, service code (the code that is this test type)

● types of test results with id, name, attributes, and service code(s) of follow­up services that are expected to be provided if the result is positive

● types of recommendations with id, name, attributes

● many-­to-­many mapping between test and results, to specify what the allowable results are for each test type

● many­-to-­many mapping between test and recommendations, to specify what the allowable recommendations are for each test type

● patient test requests with id, test type, pid, encounter, date of results

● patient test results with request id, result type, values of attributes

● patient test recommendations with request id, recommendation type, values of attributes

6. Build an interface table to map unique IDs between OpenEMR, Quest, and Labcorp. Individual practices will use facility IDs.

7. Work on API provided by Maviq to connect with Lab Exchange Network.

Specs for Lab Exchange Network

8. Build GUI for results display.

9. Create test plan for unit testing and integrated testing. Fix issues.

10. Create user documentation and maintenance guide.

Effected Code, Tables, etc

1. Here are the tables for results diplay and report. Please see MU #2 for order entry.

CREATE TABLE `procedure_report` (

 `procedure_report_id` bigint(20)     NOT NULL AUTO_INCREMENT,
 `procedure_order_id`  bigint(20)     DEFAULT NULL   COMMENT 'references procedure_order.procedure_order_id',
 `date_collected`      datetime       DEFAULT NULL,
 `date_report`         date           DEFAULT NULL,
 `specimen_num`        varchar(63)    NOT NULL DEFAULT ,
 `report_status`       varchar(31)    NOT NULL DEFAULT  COMMENT 'received,complete,error',
 PRIMARY KEY (`procedure_report_id`)

) ENGINE=MyISAM;

CREATE TABLE `procedure_result` (

 `procedure_result_id` bigint(20)   NOT NULL AUTO_INCREMENT,
 `procedure_report_id` bigint(20)   NOT NULL            COMMENT 'references procedure_report.procedure_report_id',
 `procedure_type_id`   bigint(20)   NOT NULL            COMMENT 'references procedure_type.procedure_type_id',
 `date`                datetime     DEFAULT NULL        COMMENT 'lab-provided date specific to this result',
 `facility`            varchar(255) NOT NULL DEFAULT  COMMENT 'lab-provided testing facility ID',
 `units`               varchar(31)  NOT NULL DEFAULT ,
 `result`              varchar(255) NOT NULL DEFAULT ,
 `range`               varchar(255) NOT NULL DEFAULT ,
 `abnormal`            enum('no','yes','high','low') NOT NULL DEFAULT 'no',
 `comments`            text         NOT NULL DEFAULT  COMMENT 'comments from the lab',
 `document_id`         bigint(20)   NOT NULL DEFAULT 0  COMMENT 'references documents.id if this result is a document',
 `result_status`       varchar(31)  NOT NULL DEFAULT  COMMENT 'preliminary, cannot be done, final, corrected,  incompete...etc.',
 PRIMARY KEY (`procedure_result_id`)

) ENGINE=MyISAM;

Owner and Status

Thomas Wong/Diane Carter (Intesync) - Lab Test Results

Status as of 3/15/2010: Work in progress for a listing of lab tests, database tables, and lab catalog. 100% completed.

Tony McCormick (MI2) - CPOE

Status as of 2/23/2010: Work in progress.

Yijin Woo (Maviq) - Lab Exchange Network

Status as of 3/15/2010: 100% completed.

Links

• CCHIT_MU_2011_Project
• OpenEMR Office Visit Workflow
• Labcorp Demo: http://www.labcorponline.com/flash/eLabCorp/demo.html
• Sample Lab Report: http://www.thebody.com/content/art14480.html
• Associated with Sourceforge forum thread: http://sourceforge.net/projects/openemr/forums/forum/202506/topic/3494632