Laboratory-Clinical Communications LCC

Goals The LCC Profile works in conjunction with the Lab Testing Workflow (LTW) Profile to support: – Within-system communication and documentation of order change recommendations – Within-system communication and documentation of result verification/interpretation requests – Better integration of laboratorians and pathologists into the patient care team – Better monitoring of the clinical performance of tests with improved process improvement opportunities

Participants Agreed – Epic – Cerner – Sunquest – Elekta Tentative – GE? – Others? It would be nice to get Eclypsis

Use Cases Order modification – Specimen problems – Reference laboratory problems – Laboratory-based decision support – Time-out of “future orders” Order fulfillment (post-result actions) – Results inconsistent with clinical picture (e.g., verification request) – Test interpretation request – Incorrect testing

Current LTW Transaction Sequence

Tentative LCC Implementation (additions shown in red)

LCC Development Tasks Analysis of available HL7 data elements in parallel with use case completion (2 mo) Extraction of data elements, actors, transaction patterns from use cases with mapping to HL7 data elements (3 mo) Evaluate HL7 dependencies and establish Phase II timeline – HL7 development if necessary (6 – 12 mo) LCC message construction (5 mo) Final documentation (1 mo) Initial balloting Fall 2012 or 2013 Initial Connectathon implementation Winter 2013 or 2014 Phase I Phase II

Risks Attraction and maintenance of personnel and interest HL7 data model dependencies Ballot-related delays Failure of implementation of the completed specification

Mitigating Factors Interest and support from EHR/LIS community CAP backing and logistics support Shared personnel with HL7 and the ONC S&I Framework project Relatively limited scope of application

Order Placer Order Filler Order Result Tracker Proposal of LCC profile LAB-6: Request for modification of an order LAB-7: Request on results interpretation, verification