PITUS Project A/Prof. Ken Sikaris Chemical Pathologist, Melbourne Pathology Department of Pathology, Melbourne University BSc(Hons), MBBS, FRCPA, FAACB, FFSc
Postanalytical Preanalytical The Pathology Data Cycle CBC 85027 Request Data Sample Data Pre Preanalytical EHR QUESTION OF CLINICAL NEED Test Selection Sample Collection & Transport LIS Patient Data Analysis Analytical Data ACTION FOLLOW UP Report Interpretation Report Creation Post Postanalytical Report Data Interpretative Data
The early days of pathology data transfer 1969 Medicheck & Preventicare Pathology reports to GP with IBM Call 360 by Preventicare 1998 NPAAC Guidelines for Data Communications AS4700.2, PIT / Aust-Path or HL7 / LOINC 2002 University Wollongong & Standards Australia LOINC [Problems], SNOMED [no licence] 2005 NEHTA (National E-Health Transition Authority) Business case for SNOMED CT-AUS = licence 2010 National Pathology Terminology and Information Standardisation Plan. NEHTA, NCTIS responsible for SNOMED CT in Australia. 2010 RCPA applies to Quality Use of Pathology (DOHA) for PUTS A/Prof Ken Sikaris 16 th November 2018
Pathology Units and Terminology Standardisation PUTS (12) Pathology Information Terminology and Units Standardisation PITUS 14 PITUS 16 PITUS 18-20
Senior Officers Project Manager Michael Legg Senior Project Officer (PUTS 12) Christiaan Swanepoel Senior Project Officer (PITUS 14 & 16) Donna Moore Senior Project Officer (PITUS 18-20) Vanessa Cameron
PUTS (2011-2012) Request Codes (SNOMED) Top 100 (220 Mapped) Report Codes (LOINC) Cytopathology (LOINC codes identified) Histopathology (Structured Report discussions) Genetics (not currently suited to LOINC) Haematology (107 LOINC codes mapped) Immunopathology (LOINC identified) Microbiology (SNOMED organisms, LOINC) Biochemistry (200 LOINC codes) Recognise first AACB Reference Interval Harmonisation Risk of combining results(red, Orange, Green)
PUTS
Logical Observation Identifiers Names and Codes Regenstrief Institute in Indiana, USA A definitive standard for identifying clinical information in electronic reports. LOINC codes are intended to identify the test result or clinical observation.
SNOMED (SNOMED-CT-AUS) Systematized Nomenclature of Medicine Systematically organised computer processable collection of medical terms providing codes, terms, synonyms and definitions covering diseases, clinical findings, procedures, microorganisms, substances Owned and maintained SNOMED International (prev IHTSDO) Managed and distributed in Australia by ADHA
PITUS 14 WG1 Standards Implementation Test standardisation WG2 Request Terminology SNOMED-CT-AU (227 + 261 Tests) Synonyms identified Genetics subgroup WG3 Safety in Reporting Standards for Report layout with RACGP WG4 Harmonisation Reference Limits, Significant Digits, Flags Submission to SA IT-14-6-5 committee using OBX fields in HL7 messages for handling the noncombine flag. WG5 Report Modelling Salmonella, Thyroid, Gastric, Structured Reporting Iron Studies Protocol
PITUS 14
PITUS 15-16 WG1 Standards Development and Publishing HL7 v2.4 messaging (&FIHR), Request & Report Reference Sets WG2 Safety in Pathology Reporting WG3 Request and Report Terminology 481 new SNOMED Request codes now 969 Codes WG4 Request Modelling Esp genetics WG5 Report Modelling Esp AP; Colorectal, Prostate Structured Reports WG6 Informatics Quality Assurance Test Electronic Report for Liquid Serum Chemistry Program results
PITUS 16
PITUS 18-20 WG1 Evaluation and Promotion Survey and promote the use of SPIA standards WG2 Terminology Development Maintain and expand pathology reference sets (SNOMED, LOINC) WG3 Systems Design FHIR extension & Develop Linkage systems to educational resources RCPA manual, LTO WG4 Structured Pathology Reporting Develop four new histopathology reporting protocols WG5 Report Standardisation Develop policy for flagging Develop policy for grouping tests in reports (MyHR metadata)
PUTS 2018-20 PITUS 18-20 Steering Committee Michael Legg Chair Vanessa Cameron Project Officer Ken Sikaris WG1 Chair Lawrie Bott WG2 Chair Michael Legg WG3 Chair David Ellis WG4 Chair Graham Jones WG5 Chair Rupert Lee ADHA Andrew McIntyre HL7 Australia Rob Hosking RACGP Trina Gregory RACGP Lorraine Pyefinch MSIA Simon WinterPublic Pathology Australia Grahame Caldwell Australian Pathology Derek Holzhauser RCPAQAP Robert Flatman AACB Suzanne Petrie Commonwealth DOH RCPA Debra Graves, Janet Warner, John Burnett, Vanessa White, Marion Higginson
Pathology Sector Survey (15 th November 2018)
HL7 Health Level Seven International Not for profit ANSI accredited standard Certifies standard to ISO/IEC 17065 HL7 v2.x (Message) HL7 v3 (+XML message) HL7 CDA (+Clinical Document Architecture) HL7 FHIR (Fast Health Internet Resource)..
SNOMED CT-AUS & Pathology Tests PROCEDURE Liver Function Tests 271552009 PROCEDURE Liver Enzymes 166658003 PROCEDURE Alanine Transaminase (ALT) 250637003
SNOMED CT-AUS & Pathology Tests PROCEDURE Liver Function Tests 271552009 FINDING Liver Function Test (Normal) 166602006 FINDING Liver Function Test (Abnormal) 166603001 PROCEDURE Liver Enzymes 166658003 FINDING Liver Enzymes (Normal) 143961004 FINDING Liver Enzymes (Abnormal) 143962006 PROCEDURE Alanine Transaminase (ALT) 250637003 FINDING Liver Function Test (Abnormal) 409673008
RCPA Preferred term Albumin Albumin RCPA Synonyms Usage guidance BCG method BCP method (preferred) Length 7 7 Specimen Serum/Plasma Serum/Plasma Unit g/l g/l UCUM g/l g/l LOINC 61151-7 61152-5 Component Albumin Albumin Property MCnc MCnc Timing Pt Pt System Ser/Plas Ser/Plas Scale Qn Qn Method BCG BCP LongName Albumin [Mass/volume] in Serum or Plasma by Bromocresol green (BCG) dye binding method Combining Results Flag Green Green Version 1 1 History 1.0 - Added by PUTS project Albumin [Mass/volume] in Serum or Plasma by Bromocresol purple (BCP) dye binding method 1.0 - Added by PUTS project
MyHR HL7-CDA Report
Clinical Coding SNOMED CT SNOMED CT-AUS Others Docle (MedicalDirector) Pyefinch (Best Practice) ICPC2-Plus (BEACH) ICD-10-AM (WHO) Pen-CS PHN, PIP QI Dr Tom Wenkart OpenEHR CEN13606 Dr Sam Heard ACHI (MBS) ACS (Hospitals)
Diagnostic Interface: Automation Interaction Old Current Test Catalogue Test Manual Web (v2 not in market) What tests in this case? Telephone (for exceptions) Telephone (for exceptions) Order a test Request form HL7 v2 order interface Lab report Printed report HL7 v2 message Interpretation Telephone (for exceptions) Telephone (for exceptions) Statistical Reporting Printed Reports (Manual) Excel Spreadsheets Slide Courtesy Graham Grieve
FHIR Fast Healthcare Interoperability Resources Graham Grieve (BSc, MAACB)
Diagnostic Interface: FHIR Interaction FHIR Advantage over HL7 V2 Test Catalogue API for test catalogue Integration into application What tests in this case? CDS Hooks Server Not possible in v2 Order a test Supports Order entry Easier to support across enterprise Lab report Provide Report Downstream report consumption Interpretation CDS Hooks server Not possible in v2 Statistical Reporting Automated Measure Report interface Not possible in v2 Slide Courtesy Graham Grieve
Roadmap for Pathology Data Standardisation 2008 2008 2010 2012 2014 2016 2018 2020 2022 Pathology Information Silos Laboratory Information Systems Clinical Software SNOMED & LOINC developed HL7 v2 HL7 CDA SNOMED & LOINC implemented ADHA MyHR Interoperability (FHIR) 2010 2012 2014 2016 2018 2020 2022 2024 2024
SUMMARY PITUS goal is safe interoperability for pathology. Considerable effort to enable future health informatics May be difficult to predict the future