Laboratory sends lab results to ordering provider

State: Draft

Story

Perspective: A clinical testing laboratory has a preliminary, final or amended test result to deliver.

Context: The laboratory has made the determination that it is clinically and legally appropriate to send the result to the ordering (or cc) provider.

Story: The Laboratory Information System (LIS), at defined workflow points, creates preliminary, final and amended laboratory test results relating to a specific clinical test order. Based on test result delivery instructions from the ordering provider, or from the purchaser of the test, the LIS sends each incremental laboratory test result to the recipient (or recipients) identified in the test order instructions. The LIS needs to confirm receipt of the result delivery to the Destination to conform with laboratory regulatory requirements.

With or without contingent intervening steps, ultimately the destination EHR receives the message and incorporates the lab result into the EHR.

Details

Actors

Actor	Details
Addressee	The LIS and the Destination EHR
Source	The LIS
Destination	The Destination EHR

1. There may be multiple messages tied to the same clinical order, based on the potential for various testing result statuses.
2. Some tests contain additional "copy to" (cc) destinations (e.g., a specialist orders a test and requests that the referring provider be copied on the test results).
3. Definitive confirmation of delivery is important to the LIS; in some cases confirmation of delivery (sometimes called a "report of record") may be originated by an intervening HISP prior to presentation of the test result to the destination EHR.
4. This story is limited to the return trip from the laboratory with the test results, and may need to be matched up with an original outbound test order from the EHR or HISP
5. There are potential hidden actors, such as HISPs for the Source and Destination.

Data Exchanged (This section is non-normative)

The transmitted data in this case can vary widely; some example cases are provided below:
 

1. The typical case will involve a structured lab document or message (e.g., HL7 2.x ORU message). An IFR-compliant message will be HL7 v2.5.1, with LOINC and SNOMED-CT codes (Problem -- most hospital labs lack LOINC and SNOMED-CT values to prepare a fully compliant HL7 v2.5.1 message)
2. PDF messages are sometimes attached (e.g., to provide the canonical report representation), either binary encoded in the ORU message, or attached as a BLOB

User Acceptance Tests

Run 1,000 lab result messages in parallel as hardcopy printouts from both the LIS and from the Destination EHR.