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

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)

Data Analysis Methodology Identified document sections: Element Name Length (LEN) Data Type (DT) Usage Cardinality Identified Document Segments: Message Header Acknowledgement Error Segment Patient Identification Segment Patient Visit Information Common Order Segment Observation Request Segment Time/Quality Segment Observation/Result Segment Specimen Segment Identify & Define Data Analysis Criteria Reviewed existing analysis: Previous analysis focused on optionality of elements within each segment Survey Existing Data Created master data spreadsheet : Contains data from both the Interoperable Laboratory Result to EHR (US Realm) Release 1 and Ambulatory Care Lab Result (ELINCS) Release 1 Collect Data Details Compare document sections: Analyzed element name, data type, usage, and cardinality Consolidate and Analyze Results

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 EHRs –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.

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

Element Name HL7 Definition: The name of element is specified by HL 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 HL and (ELINCS) Release 1

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 HL and (ELINCS) Release 1

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 HL Usages matched between HL and (ELINCS) Release 1

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 HL 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 HL and (ELINCS) Release 1

Data Type Example Data Types : Data TypeData Type Name CECoded Element DTDate 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 HL and (ELINCS) Release 1 The second highest similarity from all the sections

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