Clinical Order Workflows
1.0.0-ballot - STU 1 Ballot International flag

This page is part of the Clinical Order Workflows (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions

Lab Order Flow with Reference Lab

Page standards status: Informative

Lab Order Workflow with involvement of a Reference Lab - Herpes simplex virus Ab panel triggers a Herpes simplex virus Ab.IgM -

Important Information

  • This is a minimal viable definition of a possible laboratory workflow
  • This is not implementable for now but tries to show the flow of the order and the minimal needed information

Assumptions

  • Physician knows which Specimen to draw (i.e. via an Order Catalog)
  • Specimen is drawn by the Physician
  • It is clear which Order Filler will execute the Order
  • ServiceRequest is owned by the Order Placer; changes are allowed only to be done by Placer
  • Task is a shared resource of Placer and Filler and updated by both
  • Order Result is reported via DiagnosticReport
  • DiagnosticReport is owned by the Order Filler
  • Order is accepted and is fulfilled by Community Lab and Reference Lab
  • Labs internal flows are out of scope
  • Lab will trigger a Reference Lab flow because of the result of the ordered panel
  • All needed data is accessible
  • All needed data around the Sample is in the Specimen like collection information (Procedure, collection date/time, body Site, …)

    Not defined

  • Ownership of Specimen Resource (Ownership should/could/might change with the physical location - this should be defined in a more detailed Lab IG build on the COW principles)
  • Transport of the Sample

Example

Lab Order Workflow with involment of a Reference Lab- Herpes simplex virus Ab panel - Serum triggers a Herpes simplex virus Ab.IgM -PhysicianOrder Placer SystemOrder Filler 1- Community Lab -Order Filler 2- Reference Lab -Physician Workflow- not in scope -Enter OrderDraw Sampleenter Specimen InformationCOW WorkflowcreateCommunity Lab ServiceRequestOriginal ServiceRequest .code=43112-2 .intent="Order" ...createOriginal SpecimenOriginal Specimen .request->Original ServiceRequest .type="SER" ...createCommunity Lab TaskOriginal ServiceRequest  .status="active"Community Lab Task  .basedOn->Original ServiceRequest  .focus->Original ServiceRequest  .input->Original Specimen ...sendCommunity Lab Task toCommunity Laball needed data is accessed by Community Labownership ofSpecimenmight be transfered to Community LabSpecimen gets a Asscension ID of the Community LabAcceptOriginal ServiceRequestCommunity Lab Task .status=="accepted" .owner-> Order Filler businessStatusis set appropriatewait for SpecimenSetTaskin-progressCommunity Lab Task .status=="in-progress" businessStatusis set appropriateCommunity Lab Workflow- not in scope -Create an Aliquotand a new Specimen ResourceAliquot Specimen .parent->Original Specimen ...Execute theOriginal ServiceRequestCreate Reference Lab Reflex Orderbecause of ProtocolcreateReference Lab ServiceRequestReference Lab ServiceRequest .code=16944-1 .intent="Order" ...updateAliquot" Specimen  for Reference LabAliquot Specimen .request->Reference Lab ServiceRequest .type="SER" ...createReference Lab TaskReference Lab ServiceRequest  .status="active"Reference Lab Task  .basedOn->Community Lab ServiceRequest   .focus->Reference Lab ServiceRequest  .input->Aliquot Specimen ...sendReference Lab Task toReference Laball needed data is accessed by Reference Labownership ofReference Lab Specimen might be transfered to Reference LabAccession ID is set to Reference Lab needsAcceptReference LabServiceRequestReference Lab Task .status=="accepted" .owner-> Reference Lab businessStatusis set appropriatewait for Reference Lab SpecimenSetTaskto in-progressReference Lab Task .status=="in-progress" businessStatusis set appropriateReference Lab Workflow- not in scope -Execute OrderCreateReference Lab DiagnosticReportResult of Order executionis filled intoDiagnosticReportReference Lab DiagnosticReport .basedOn=ServiceRequest ...UpdateReference Lab TaskReference LabTask .output->Reference Lab DiagnosticReport  .status="completed"The Community Lab gets information that the Reference Lab Task is finished via- Subscription- polling- messaging- ...Community Lab Workflow- not in scope -CreateCommunity Lab DiagnosticReportResult of Reference Lab executionand Community Lab executionis added toDiagnosticReport Community Lab DiagnosticReport .basedOn=Original ServiceRequest ...UpdateReference Lab ServiceRequestReference Lab ServiceRequest .status="completed"UpdateCommunity Lab TaskCommunity Lab Task .output->Community Lab DiagnosticReport  .status="completed"The Order Placer gets information that the Task is finished via- Subscription- polling- messaging- ...UpdateOriginal ServiceRequestOriginal ServiceRequest .status="completed"Result Reporting to Physician- not in scope -ReportCommunity Lab DiagnosticReport