CHCS Lab – Introduction/Basic SAFMLS 2011 - CHCS Workshop Maj Chip Hopkins, USAF, BSC (ret) Capt Karen Chisholm, USAF, BSC

Objectives Review Common CHCS Functions Review Reports Review Lab Test File and Table Build Introduce Laboratory Interop

CHCS COMMON FILE AND TABLE BUILD

Lab Division File (LDV)

Lab Division File (Page 2)

Lab Division File (Page 3)

LABORATORY WORK ELEMENT LWE

LWE

LWE

You can determine your own shifts, this will populate on your SDR/SSR

LWE- Page 2

COMMON CHCS REPORTS

Specimen Master Log- SLG

SLG

SLG

Test Patient, Joe

30/123-45-6789

SRE/SRP

ABNORMAL, CRITICAL AND DELTA RESULT REPORT- ACR Review by Exception vs. daily review of SLG

ACR

ACR Test Patient, Jane

30/123-45-6789

Deleted, Amended, Changed Tests Report

-DAC

DAC

DAC

You can either spool the report or print to screen

DAC

Test Patient, Jane

30/123-45-6789

WORK LOAD REPORTS

Workload Statistics Detail Report (SDR) Pathway= ^SDR/ ^SSR

Specimen Workload Report (SSR/SDR)

DATA FOR SSR/SDR PULLED FROM HERE.

PLP

Performing Lab Processing Report ^PLP

PLP

PLP

PLP

PLP

SLP

Submitting Lab Processing Report ^SLP

SLP

SLP

SLP BE AWARE OF WHAT YOU ARE SENDING TO COMMERCIAL LABS

SLP REPORT- Spool the report

You can spool the report for Retrieving it at another time

SLP- Log the report

Here you will go to Log, so you can capture your data

SLP- Logging MAKE SURE YOUR LOGGING ON IS CHECKED

MAKE SURE YOU CHECK THE DISK BOX TOO!

SLP- Logging

CHECKING THE DISK BOX WILL BRING UP ANOTHER MENU SO, YOU CAN SAVE YOUR REPORT TO EXPORT IT TO A SPREADSHEET

SLP- Logging

CLICK ‘OK’

SLP- Logging

SLP- Importing a report to Excel 1. Open Excel document 2. Choose “From Text” 3. A window opens to choose document 4. Click “Import”

Importing to Excel

Importing to Excel

-You will want to scroll down to see how you want to separate the information -You can move or delete the separators - Then, click “Next”

Importing to Excel

Then, click “Finish” Gives you an opportunity to customize the cells

Importing to Excel

You have a nice document that you can clean up

Importing to Excel

LAB FILE AND TABLE BUILD

Lab Test Considerations Does test exist in the DOD Standard Lab Test file. (Try multiple naming conventions, i.e., the test you need could use a different name)? Will this test utilize Lab Interop? If so, have you added this test as a Reference Lab Test file (RLT)? Do you have all of the information necessary to build this test. (Sample Requirements, Normal Ranges, CPT code, Result Code from Performing Lab)?

Lab Test Considerations Will you need to create a new Collection Sample for this test? Will this be a Single or Panel Test? What Accession Area will be used for this test? If shared platform (Multiple Divisions / Lab Work Elements), have you considered how each site will handle this new test? 

If it’s a ship out, will they need their own Accession Area or do you want this to come on a Transmittal List from them?

DOD Standard Lab Test File

Adding DOD Std Single Test (LTE)

Adding DOD Std Single Test (LTE)

Lab Test File (LTE)

Accession Area File (AAE)

Lab Test File (Page 2)

Collection Sample (in LTE)

Collection Sample (Page 2)

Collection Sample (CSE)

Lab Test File (Page 2)

Lab Method (in LTE)

Site/Specimen (in Lab Method)

Reference Value (in Site/Specimen)

Reference Value Examples Based on multiple Age Groups and Sex

Reference Value Examples Upper Limit Calculation: DAYS/365.25 

Applies on age groups less than 1 YR

Reference Value Examples Female

Lab Method Examples Secondary Test (Reflex Test)

Lab Method Examples Set of Codes / Result Codes

Lab Method Examples Result Code – stored Expansion – displayed (DO NOT EDIT) Result String – comes from Instrument

Lab Method Examples Calculated Test

Lab Test File (Page 2)

Lab Work Element (in LTE)

If it needs to be different than the MTF Lab Method

Lab Test File (Page 2)

Inactive Flag (in LTE)

Interop Submitting Lab Lab Work Element

Interop Submitting Lab

Default must be set to YES or system will assume the test is performed in house.

Panel Test (LTE)

Lab Work Element (in Panel)

Panel Test (Page 2)

DO NOT ADD OR DELETE TESTS FROM A PANEL…EVER !!!

Lab Interoperability (LIO)

Objectives CHCS Lab Interoperability (LIO) - Overview LIO – Network / Virtual Private Network (VPN) LIO - Interfaces LIO – Interfaces and Firewalls LIO – Messaging – HL7 LIO – File / Table Set-up LIO - Troubleshooting

LIO – Overview A. Orders/Accessions E. Orders/Accessions

A. Orders/Accessions

A. CHCS Submitting Laboratory

B. Results E. Results

B. Results C. Results D. Results

Internet via VPN

B. CHCS and EpiLab Performing Laboratory A. Orders/Accessions C. Results

E. Orders/Accessions

E. Results

E. VA Submitting Laboratory

A. Orders / Accessions

C. VA Performing Laboratory

D. Results

D. Commercial Performing Laboratories (LabCorp, Quest)

LIO – Network / VPN Lab Interoperability HL7 Inbound Msg

Workstation

HL7 Outbound Msg

Workstation

WAN/ Internet

V P N

TCP/ IP

CHCS Server Site A

VPN HL7 Outbound Msg

HL7 Inbound Msg

VA Reference Lab Server

V P N

HL7 Inbound Msg

Workstation

HL7 Outbound Msg

CHCS Server Site B

VPN HL7 Outbound Msg

HL7 Inbound Msg

Commercial Reference Lab Server

Workstation

LIO – Interfaces Lab Interoperability HL7 Inbound Msg

Workstation

HL7 Outbound Msg

Workstation

CHCS Server Site A

V P N

WAN/ Internet TCP/ IP

V P N

HL7 Inbound Msg

Workstation

HL7 Outbound Msg

CHCS Server Site B

Workstation

To enable a site to communicate with another site, an ‘Interface’ must be built at each site Interfaces allow communication from one site to another, CHCS, VA or Commercial

LIO – Interfaces & Firewalls LIO Interfaces are built by CHCS System Administrators and if not built correctly will not work…and must be done at both sites In order for an interface to be permitted to get to and from a destination through firewalls and VPNs, “exceptions” are required It ‘may’ take weeks to obtain firewall exceptions; you must be patient and persistent

LIO – Interfaces & Firewalls Once the interfaces have been built, the firewall exceptions entered, the interface must be tested to confirm the information can transit the network Troubleshooting can be a complex task and coordination between the site’s network shops, TIMPO, DISA are essential…and patience is absolutely required

LIO – Messaging – HL7 The messaging used in LIO interfaces are Health Level 7 or HL7 messages, which is a standard in the healthcare system worldwide Different vendors, labs, etc, may use different versions, ‘flavors’ or variations of HL7 which must be resolved in development prior to deployment

LIO – Messaging – HL7 HL7 is used for outbound order messages: MSH^\|~&^CHCS\LRACC^24835^CHCS\LRACC^AMT^20100317135000^^ORM\O01^N00183-1339125565^P^2.2^^^AL^ER^ PID^1^^6824811\\\N00183\^02/800-00-0505^ZZLIONMCP\CHILD\MALE\\\^^19920605000000^M^^^^^^^^^^^^^^^^^^^ ORC^NW^100317 PQF 2034^^AMT-N00183-224^CM^^1\&1349&\D1\20100317134900\20110317134800\R\2^^^^^^ OBR^1^100317 PQF 2034^^227X\ALDOLASE\L\417\ALDOLASE\99LST^^^20100317134900^^^^P^^^^72&SERUM&99LRP\\\ 18&BLOOD&99LRS^279249\HOPKINS\CHARLES\ROBERT\\\\99STF^^100317-15205-122986074^^^^^^^^^1\&1349&\ D1\20100317134900\20110317134800\R\2

HL7 Messages are composed of different message segments, which carry different pieces of information. Order messages may contain the following: MSH, PID, ORC, OBR, OBX, NTE, Z-segments, etc

SUMMARY Reviewed Common File and Table Build Reviewed: ACR, DAC, PLP, SLG, SLE, SLP, etc Reviewed Lab Test File and Table Build Laboratory Interoperability (LIO)

LIO Resources, Assistance, Help Contact your Performing Lab (or those who work with them, e.g., Maj Chip Hopkins) Other personnel / sites using LIO with Ref Lab ‘LabInterop.org’ / ‘LabInteroperability.org’ (This website is currently under development and will list all Performing Labs, DOD and Commercial, along with information relevant to them, including Test Menus / links, Lab contact info, Lab Order Required Data (Ask at Order Entry (AOE) questions), LIO ad hocs and other relevant information)

www.LabInterop.org

www.LabInterop.org

www.LabInterop.org

www.LabInterop.org

www.LabInterop.org

www.LabInterop.org

www.LabInterop.org

www.LabInterop.org

Q & A – Additional Anyone

Anyone

Anyone

Bueller?

Thank you! Charles R. “Chip” Hopkins, Maj(ret), USAF, BSC Mobile: 619.804.2234 [email protected] Karen Chisholm, Capt, USAF, BSC Kadena AB, Japan, DSN: 315.630.4158 [email protected] Some slides courtesy of WHMC