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Order Laboratory Test

Electronic Medical Records (EMRs) systems can send an electronic lab order to a laboratory information system (LIS).

Workflow Maturity

Newly Defined
  • Workflow is defined and ARB approved
  • Initial implementations are being implemented
Standards
  • FHIR R4 search on Task, DiagnosticReport, ServiceRequest or Patient resources
  • FHIR R4 bundle search response
  • FHIR R4 Workflow
Assumptions and Prerequisites
  • The EMR and LIS are trusted applications known by the IOL
  • The IOL supports node authentication, audit tracking, and rerunning of failed transactions
  • The SHR adheres to OHIE specification
Actors
  • EMR - The electronic medical record system that captures the patient and order information and sends the electronic order to the LIS
  • LIS - The laboratory information system that pulls order information, processes orders, updating statuses and generating results sets
  • IOL - The interoperability layer that secures and orchestrates the exchange of information (see OHIE Interoperability layer)
  • SHR - The shared health record that serves as a centralized data store for patients’ longitudinal health record

Interaction Description

# Interaction Data Transaction Options
1 Create Lab Order The order save generates a FHIR R4 Task Resource (see example here) Alternatively, the order save could generate a FHIR R4 ServiceRequest Resource for direct transmission.
2 Send New Lab Order FHIR Task bundled order is sent to the IOL and consists of a FHIR R4 Task Resource and a referenced FHIR R4 Patient Resource (example). Task status is aligned with the FHIR workflow communication pattern found here

FHIR R4 bundle (example)

Alternatively a FHIR R4 ServiceRequest and Patient Resource bundle could be sent
3,4 Send New Lab Order Bundled order is routed through the IOL to both the SHR and the LIS FHIR R4 bundle (example)
5 Save Order and Update Order Status FHIR R4 Task Resource Status is updated locally to either rejected or accepted. A FHIR R4 ServiceRequest Resource (example) is created for order processing with a reference to the associated task. EMR test requests and LIS orders are matched based on LOINC codes. Alternatively, a ServiceRequest with a link to the referenced ServiceRequest could be populated.
6 Send Order Update Update Task Resource Status from [5] is sent to the IOL Alternatively, this could be an update to a FHIR R4 ServiceRequest resource
7,8 Send Order Update IOL routes the updated FHIR R4 Tasks to the SHR and the EMR See transaction options [6]
9 Update FHIR Task Status FHIR task status updated locally See transaction options [6]

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