2 HL7 field definitionsOBR-25: This field is the status of results for this order. This conditional field is required whenever the OBR is contained in a report message. It is not required as part of an initial order. If the status is that of the entire order, use ORC-15-order effective date/time and ORC-5-order status. If the status pertains to the order detail segment, use OBR-25-result status and OBR-22-results report/status change - date/time. If both are present, the OBR values override the ORC values.
3 HL7 field definitionsOBX-11: This field contains the observation result status. Refer to HL7 table Observation result status codes interpretation for valid values. This field reflects the current completion status of the results for one Observation Identifier.
4 HL7 field definitions ORC-5: This field specifies the status of an order. Refer to HL7 Table Order status for valid entries. The purpose of this field is to report the status of an order either upon request (solicited), or when the status changes (unsolicited). It does not initiate action. It is assumed that the order status always reflects the status as it is known to the sending application at the time that the message is sent. Only the filler can originate the value of this field. Although HL7 Table Order status contains many of the same values contained in HL7 Table Order control codes and their meaning, the purpose is different. Order status may typically be used in a message with an ORC-1-order control value of SR or SC to report the status of the order on request or to any interested party at any time.Notes:Used for status updating mostly – when ORC-1 is SR or SC.Could ‘A’ and ‘CM’ be helpful to indicate if completed order or not, so that OBR-25 can be used to indicate the correction to a report?Not used in LRI, keep that way
5 CLIA definitions - Reports The laboratory must have a system for retaining copies of all reports including original, preliminary, corrected, and final reports. This includes computer-generated reports.From
6 CLIA definitions - Reports Original report: also mentioned in CLIA 1200 as well as the Guidance document – but not further defined – seems to be whatever report comes before the corrected – is not a status, so no need to represent using status codes
7 CLIA definitions - Reports Preliminary report means a test result that has been reported to the authorized person, laboratory, or entity such as an electronic health record or health information exchange that initially requested the test before the final test result is completed. Frequently, a preliminary report will contain significant, but not definitive information (e.g. a urine culture preliminary report of >100,000 Gram-negative bacilli after 24 hours incubation or a beta subunit preliminary report of >200 miu/ml). It should be noted on the report when the result is a preliminary result and that a final report will follow.OBX-11 = ‘P’, OBR-25 = ‘P’
9 CLIA definitions - Reports Corrected reports, either hard copy or electronic, must clearly indicate both the corrected result(s), and the fact that the report is a corrected report. The corrected reports should be promptly sent to the authorized person and to all known recipients of the original incorrect report. Errors in test results may include incorrect patient identification, test results, reference or normal ranges, interpretive information, or other significant information.OBX-11 = ‘C’, OBR-25 = ‘C’When deleting a result:OBX-11 = ‘D’ to allow NTE capability?When deleting result from incorrect patient:OBX-11 = ‘W’, OBX-25 = ? – report test as canceled and order new for correct patient
10 CLIA definitions - Reports Partial report: A “partial report” means multiple tests are ordered on the same specimen or patient. If partial reports are issued for only those tests that have been completed, then the report date will be the date when all tests have been completed. However, the laboratory should be able to identify the date that each new test is appended to the report. This also applies to electronic reports.HL7 captures this ONLY at the OBR level reliablyShould we send ALL OBXes using ‘I’ or only send Final OBXes, omitting the others?OBX-11 = ‘F’ and ‘I’, OBR-25 = ‘A’OrOBX-11 = ‘F’ for all available, OBR-25 = ‘A’
11 CLIA definitions - Reports Amended cytology report:D5625: Must have written policy to detect errors – previous results in patients up to past 5 years / cytology vs histo pathology / clinical vs cytology – must issue amended report, if significant discrepancies found.D5659: Must indicate the basis for correctionOBX-11 = ‘C’, send NTE, OBR-25 = ‘C’Reference: https://www.yumpu.com/en/document/view/ /aspen-federal-regulation-set-agency-for-health-care-administration/184
12 No results availableOBX-11 = ‘X’ – tried to get results, but couldn’t OBX-11 = ‘N’ – didn’t try to perform ordered test – do we need this one – not used in IHE? If some OBX-11 = ‘X’ and some = ‘F’, then OBR-25 = ‘F’ If all OBX-11 = ‘X’ or should be ‘N’? , then OBR-25 = ‘X’ – would we need to list all OBXes under OBR-25 = ‘X’?
14 Rules for the message Only when ALL OBX-11 under OBR are: Then OBR-25 should be:FXNWIWho uses ‘I’? - Who uses ‘S’? – Who uses ‘N’?For OBR-25 ‘W’ would be a new code to harmonize with FHIR vocabulary
15 Rules for the message P I Who uses this code? A R when at least 1 OBX-11 under OBR is:Then OBR-25 should be:PIWho uses this code?ARNOT USED OUTSIDE THE LAB - DROPR or A?Cand none are P or I or RNot required by CLIA - DROPM or C?DCLIA does not allow deletion - DROPBB or F?VFNand none are P or I or R or A/C/D/W/B?XDo we need to support ‘N’?