LRI+-+Scope+Considerations+-+Suggested+Text

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Suggested Text for List of In Scope Tests
The goal of S&I framework is to encourage the broad deployment of a low cost standard interface for the transmission and receipt of laboratory results in the ambulatory care environment. To avoid multiple interfaces at both the laboratory and ambulatory EHR, the interface must accommodate all test results that will be transmitted electronically. The failure to achieve the above goals will have a significant negative impact on the electronic communications of laboratory results, harmonization of laboratory data, and the ability of physicians to meet the goals of meaningful use in all phases.

Therefore, the S&I framework for laboratory test interfaces should accommodate all laboratory results. To avoid a situation where complex data requirements of certain results (e.g. specific anatomic pathology, cytology, genetics tests) would cause exclusion, the scope will support these tests without current constraint on format or clinical terminology (e.g. as PDFs or data blobs). The balance of the laboratory tests that have standard reporting formats as defined below will be broken into two categories:
 * A. Those with standard terminology (e.g. LOINC and SNOMED CT where available or appropriate).
 * B. Those that may have laboratory specific local terminology used in the electronic reporting of the results.

For category A, the recommended minimum list of tests that should be LOINC coded will be taken from Appendix A of the ELINCS Version 1.1 specification which has expanded to include appropriate microbiology, cytology and genetic tests.

The list of standard reporting formats shall include:
 * 1) Tests and/or components with numeric results, units, and normal ranges
 * 2) Tests and/or components with a limited set of textual results with or without normal ranges (please add to these examples)
 * Example 1: positive/negative/indeterminate, resistant/intermediate/susceptibility
 * Example 2: cytology / AP
 * Example 3: mutation type and location
 * Example 4: organism name
 * 1) Tests with defined structure in OBX-3  thru OBX-8   for the reporting of Culture Results and Antimicrobial Sensitivities (see ELINCS V1.1 for examples)
 * 2) Semi Structured or Unstructured
 * Tests and/or components reported in a PDF or data blob

If the targeted format cannot be met, then it is acceptable to use an alternate reporting format that conveys the result information and contains as much of the discreet meaning of the result as possible.

To meet these goals, the initial deployment for the resulting LRI S&I framework should accommodate the full range of laboratory tests as described above utilizing an existing standard (e.g. HL7 2.5.1) constrained with an existing implementation guide (e.g. ELINCS). The initial set of tests that should be addressed for harmonization and to determine success metrics should encompass or be selected from the list of LOINC coded tests above.

For pilot and test purposes a test from each category should be selected.

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