Lab Integration Workflow

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The Lab Order workflow between OpenELIS and OpenMRS will use the FHIR Workflow Module and suggested Communication Patterns to implement the ordering of lab tests from OpenMRS to OpenELIS and the returning the results to OpenMRS.

The current communication workflow uses HL7 V2.5.1 messages as documented here: (https://github.com/openelisglobal/openelisglobal-core/wiki/Result-Reporting). This functionality is implemented in openmrs-module-labintegration, an OpenMRS module made for an implementation of OpenMRS deployed in Haiti called iSantePlus.

Communication Overview

Implementation Guide

Install iSantePlus using the following instructions:
1. links to code etc.
Install the OpenMRS FHIR module
Install the OpenMRS iSantePlus Lab on FHIR module
Start up the Update Task.
Install OpenELIS

Required FHIR Resources

Task

> more info

The Task resource is created along with the corresponding ServiceRequest resource when a clinician creates a TestOrder and decides to send it to OpenELIS.

This resource is used to track the status of the lab order request from initiation to completion, and as a container for all other resources related to the given order.

Example Task:

{
    "resourceType": "Task",
    "id": "88ffa7fb-0419-4097-8b45-24f0d843c5ea",
    "identifier": [
        {
            "system": "http://isanteplus.org/ext/task/identifier",
            "value": "88ffa7fb-0419-4097-8b45-24f0d843c5ea"
        }
    ],
    "basedOn": [
        {
            "reference": "ServiceRequest/ebf83ba0-9d3c-497f-9aa0-d839ec506202",
            "type": "ServiceRequest"
        },
        {
            "reference": "ServiceRequest/73e96ecb-a78d-41c8-a55f-d9b90f759e5f",
            "type": "ServiceRequest"
        }
    ],
    "status": "requested",
    "intent": "order",
    "for": {
        "reference": "Patient/e14e9bda-d273-4c74-8509-5732a4ebaf19",
        "type": "Patient"
    },
    "encounter": {
        "reference": "Encounter/7f5aabd9-6375-47c8-a8d6-30f219b6e2f1",
        "type": "Encounter"
    },
    "authoredOn": "2020-04-28T17:33:19+00:00",
    "owner": {
        "reference": "Practitioner/f9badd80-ab76-11e2-9e96-0800200c9a66",
        "type": "Practitioner"
    }
}

ServiceRequest

> more info

The ServiceRequest resource represents the TestOrder placed in OpenMRS. It is referenced from the Task with the Task.basedOn element, and sent to OpenELIS with the Task to initiate the processing of the order.

Example Service Request:

{
    "resourceType": "ServiceRequest",
    "id": "73e96ecb-a78d-41c8-a55f-d9b90f759e5f",
    "status": "active",
    "intent": "order",
    "code": {
        "coding": [
            {
                "code": "790AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
            },
            {
                "system": "http://loinc.org",
                "code": "14682-9"
            },
            {
                "system": "urn:oid:2.16.840.1.113883.3.7201",
                "code": "790"
            }
        ]
    },
    "subject": {
        "reference": "Patient/e14e9bda-d273-4c74-8509-5732a4ebaf19",
        "type": "Patient"
    },
    "encounter": {
        "reference": "Encounter/7f5aabd9-6375-47c8-a8d6-30f219b6e2f1",
        "type": "Encounter"
    }
}

DiagnosticReport

> more info

The DiagnosticReport resource is the container for the results of an Order, and holds these results in the DiagnosticReport.result element as references to Observation resources.

Example Diagnostic Report

{
  "resourceType": "DiagnosticReport",
  "id": "93",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2020-04-28T17:33:36.163+00:00",
    "source": "#55t4lpDZF4q3TCZ0"
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><div class=\"hapiHeaderText\"> Untitled Diagnostic Report </div><table class=\"hapiPropertyTable\"><tbody><tr><td>Status</td><td>FINAL</td></tr></tbody></table></div>"
  },
  "identifier": [
    {
      "system": "https://isanteplusdemo.com/openmrs/ws/fhir2/",
      "value": "ebf83ba0-9d3c-497f-9aa0-d839ec506202"
    }
  ],
  "status": "final",
  "code": {
    "coding": [
      {
        "code": "1008AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
      },
      {
        "system": "http://loinc.org",
        "code": "22748-8"
      },
      {
        "system": "urn:oid:2.16.840.1.113883.3.7201",
        "code": "1008"
      }
    ]
  },
  "subject": {
    "reference": "Patient/2"
  },
  "result": [
    {
      "reference": "Observation/92",
      "type": "Observation"
    }
  ]
}

Observation

> more info

The Observation resource contains the results of the Lab Order request.

Example Observation:

{
  "resourceType": "Observation",
  "id": "92",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2020-04-28T17:33:36.124+00:00",
    "source": "#xAVz0uUE6c3l42Za"
  },
  "identifier": [
    {
      "system": "https://isanteplusdemo.com/openmrs/ws/fhir2/",
      "value": "ebf83ba0-9d3c-497f-9aa0-d839ec506202"
    }
  ],
  "status": "final",
  "code": {
    "coding": [
      {
        "code": "1008AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
      },
      {
        "system": "http://loinc.org",
        "code": "22748-8"
      },
      {
        "system": "urn:oid:2.16.840.1.113883.3.7201",
        "code": "1008"
      }
    ]
  },
  "subject": {
    "reference": "Patient/2"
  },
  "valueQuantity": {
    "value": 55,
    "unit": "UI/L"
  }
}

Patient

> more info

The Patient resource contains vital information for OpenELIS to fullfill the lab order request, and is referenced by the Task.

Example Patient:

{
    "resourceType": "Patient",
    "id": "e14e9bda-d273-4c74-8509-5732a4ebaf19",
    "identifier": [
        {
            "id": "5981a256-d60c-44b1-beae-9bdd2cf572f8",
            "use": "official",
            "system": "iSantePlus ID",
            "value": "10012R"
        },
        {
            "id": "75a67d54-6fff-44d1-9c3e-2116c967b475",
            "use": "usual",
            "system": "Code National",
            "value": "100000"
        },
        {
            "id": "29447d21-3cd6-42a9-9ab2-79ebfa710a01",
            "use": "usual",
            "system": "ECID",
            "value": "04d759e0-5d02-11e8-b899-0242ac12000b"
        }
    ],
    "active": true,
    "name": [
        {
            "id": "511275de-e301-44a3-95d2-28d0d3b35387",
            "family": "Mankowski",
            "given": [
                "Piotr"
            ]
        }
    ],
    "gender": "male",
    "birthDate": "1987-01-01",
    "deceasedBoolean": false,
    "address": [
        {
            "id": "d4f7c809-3d01-4032-b64d-4c22e8eccbbc",
            "use": "home",
            "country": "Haiti"
        }
    ]
}

Deliverables (Lab)

Demo - continuity of care pilot -
Public Communication - OpenMRS Talk/Design Forum/
Documentation - functional and technical reqs (HIE doc, implementation guide, Wiki page contents)
Present at OpenMRS & OpenHIE

Relevant FHIR Docs

Using Tasks in a RESTful Context: https://www.hl7.org/fhir/task.html#12.1.2.1
Workflow Module: https://www.hl7.org/fhir/workflow-module.html
Diagnostic Module: https://www.hl7.org/fhir/diagnostics-module.html
Example: Workflow states for a lab order for a blood test: https://www.hl7.org/fhir/workflow-communications.html#12.6.2.1
Option G: POST of Task to fulfiller's system: https://www.hl7.org/fhir/workflow-management.html#optiong

Relevant Talk Posts

The handling and mapping of lab order status for the lab workflow

Lab Integration Workflow

Communication Overview

Implementation Guide

Required FHIR Resources

Task

ServiceRequest

DiagnosticReport

Observation

Deliverables (Lab)

Relevant FHIR Docs

Relevant Talk Posts

Relevant Github Links