A few months ago I wrote about the ELINCS EDGE testing tool, a free program that allows you to easily test your interfaces against ELINCS compliant HL7 result messages. For those unfamiliar with the existing standard, ELINCS (EHR-Lab Interoperability and Connectivity Specification) is an HL7 v2.x based message profile used for the reporting of lab results from laboratory information systems to ambulatory EHRs.
This month, the California Healthcare Foundation has released the “ELINCS Orders Draft Specification Version 0.2” for public comment. This new specification addresses the electronic submission of clinical orders between providers, EHR systems, and LIS systems, through a constrained version of an HL7 v2.5.1 “OML” lab order message as applied to several use cases.
According to the draft, the use cases do not assume that the results are formatted per the ELINCS HL7-R1 specifications for results reporting. However, they do “strongly” recommend that labs use the ELINCS HL7-R1 format to report the results of tests ordered using the ELINCS Orders message format. This essentially means that you do not need to have a pre-existing ELINCS compliant results distribution in place in order to implement the orders specification. It is, however, recommended since the implementation of both specifications should work together to “close the loop” on the entire electronic order requisition and result distribution workflow.
Specifically, the new draft specification defines the following required transaction use cases:
- Order Request Transmitted Electronically to Lab (from the EHR)
- Cancel Request Transmitted Electronically to Lab (from the EHR)
Optionally supported use cases include:
- Cancel Notification Transmitted Electronically to EHR (from the LIS)
- Status Request Transmitted Electronically to Lab (from the EHR)
- Status Response Transmitted Electronically to EHR (from the LIS)
The specification details the multiple “typical” use cases above, and also explicitly states that it does not encompass several other typical scenarios (at least as of the draft date). Two examples of use cases that are not defined are the transmission of a lab compendium of tests, and the case where reflexed lab orders in the LIS request new requisition identifiers for the reflexed test from the EHR.
Another item of interest is that the ORM order message is not defined for use within the specification. Therefore, if your EHR or LIS system typically communicates orders via the “ORM” message type (as opposed to the OML), then you will likely need to perform a gap analysis of the specifications and any available message data, to determine if you could convert the ORM orders messages to the OML format, and vice-versa, via an integration engine, or some other method.
Public comments on the draft specification will be accepted by CHCF through April 11, 2011, and is available for download from the CHCF website: http://elincs.chcf.org/specifications.aspx.