FHIR Chat · Acknowledging Laboratory Test Results

Stream: implementers

Topic: Acknowledging Laboratory Test Results

Rod McDonald (Jul 02 2017 at 20:42):

It is common practice for clinicians to acknowledge that they have viewed test results on-line and documented their follow-up actions. This acknowledgement process ensures that laboratory test results are acted on promptly and hopefully avoids results being missed for whatever reason. This acknowledgement process can require a passing of responsibility between different clinicians before the relevant follow-up actions are documented and the acknowledgement step completed. What have other implementors found are the relevant FHIR resources for supporting this process?

Richard Townley-O'Neill (Jul 02 2017 at 23:39):

ClinicalImpression ?

Elliot Silver (Jul 04 2017 at 18:17):

IHE Radiology is preparing a profile for a similar use around follow-up of non-critical secondary findings. They are using Communication (and CommunicationRequest). If I recall correctly, there is an initial communication of "hey, here's something you might want to follow-up on," and a response communication of "OK, I'll look into it."

Kevin Mayfield (Jul 18 2017 at 10:47):

@Elliot Silver is any of that work available online? We've been looking acknowledging tasks being reviewed/acknowledged by clinicians. Have looked at using STU3 Task resource (https://gist.github.com/KevinMayfield/516ca6eb42345e879f93a6eb158b5c34) or using DSTU2 OrderResponse (and other resources)

Dilraj Bhatia (Jul 18 2017 at 13:34):

Hi all, we have a similar use case that we are trying to solution using FHIR DSTU2 resources. Please could anyone suggest what resources would meet the requirement of acknowleding or ignoring of lab order results by a clinician. We are finding it difficult to solution it using FHIR DSTU2 resources, FHIR DSTU3 resources would have suited the solution better.
The user scenario is:

Clinician orders a test
Lab runs the test
Lab returns the test result
Clinician views the test result (in scope)
Clinician acknowledges or ignores the test result (in scope)
Underlying system(s) will get updated that results have been acknowledged or ignored.(in scope)
Items marked in scope is what we are trying to solution. We would like to know which resources would suit steps 5 and 6.
I am also sharing the business process model and use case diagram for the same:
Business Process Model
SouthamptonUHSBPM.png
Use case:
SouthamptonUHSUseCase.png

Dilraj Bhatia (Jul 18 2017 at 13:39):

@Kevin Mayfield and I think that 'OrderResponse' resource might suite the requirement of acknowledge lab order results by clinicians. Would be interested to know your thoughts on this.

Lloyd McKenzie (Jul 18 2017 at 13:43):

In STU3 you'd use ProcedureRequest, Observation, DiagnosticReport and Task. In STU2, DiagnosticRequest = ProcedureRequest and Order+OrderReponse = Task. You may find that Order+OrderResponse need extensions to be useful, but in theory they should work.

Dilraj Bhatia (Jul 18 2017 at 13:52):

Thanks a lot @Lloyd McKenzie That's a very useful description of mappings - mapping v2 resources to their equivalent V3 resources.

Kevin Mayfield (Jul 18 2017 at 13:55):

Here is a OrderResponse (DSTU2) we mocked up https://gist.github.com/KevinMayfield/5ce742eb62ab167657320d0579cfd127

Dilraj Bhatia (Aug 01 2017 at 08:39):

Hi all, I have expanded the lab order, lab results, assigning and acknowledge or ignore test results requirements into a more comprehensive use case. Please could anyone suggest what FHIR DSTU2 resources would suit which parts of this use case. Functionality:
1. Clinician orders tests - (DiagnosticOrder resource)
2. Lab technician runs the test and returns the test result -> clinician views test result - (DiagnosticResponse)
3. Lab requests technical confirmation of receipt of test result by clinician - (Order)
4. Clinician's system confirms receipt of test result - (OrderResponse)
5. Lab requests review of test result by clinician - (Order or ProcessRequest)
6. Clinician acknowledges or ignores the test result - (OrderResponse)
7. Clinician might decide to assign the test result to some other clinician - (?? resource)
8. Only clinician to whom the test result is assigned can choose to acknowledge and ignore test result.
Please find the complete process diagram for the same as follows: