Laboratory+Orders+Interface+Charter+Page

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toc **Consensus voting is CLOSED on the LOI Initiative Charter. Review the votes.** **For your convenience, the FINAL Initiative Charter is also available as a .**

**1.0 Initiative Summary**
The Laboratory Orders Interface (LOI) Initiative is focused on the creation of an Implementation Guide (IG) for the ambulatory setting that builds on the architecture and design of the California HealthCare Foundation’s (CHCF) EHR-Lab Interoperability and Connectivity Specification (ELINCS) Laboratory Orders and the Health Level Seven (HL7) Version 2.5.1 Implementation Guide: S&I Framework Lab Results Interface, Release 1 - US Realm (July 2012)(LRI IG).

Further, the Initiative seeks to design an IG that can serve as a foundation for eventual use in acute care and public health and incorporate vocabulary consistent with the above mentioned guides as well as support for the HL7 Electronic Directory of Service (eDOS) IG. Additionally, tools will be developed to aid evaluation and adoption of messages compliant with the LOI IG generated by Electronic Health Records (EHR) Systems and Laboratory Information Systems (LIS).

**2.0 Challenge**
The lack of a single, comprehensive implementation guide for laboratory orders interfaces is a major gap in the healthcare standards portfolio. The lack of clear and interoperable implementation guidance for laboratory orders that is aligned with other laboratory data exchange implementation guidance drives up the cost, effort, and time to implement an interface and consequently hampers broad adoption of such interfaces.

**3.0 Value Statement**
Laboratory orders interfaces automate the electronic communication of test order information between EHR Systems and LISs. To date, there is no consistent implementation guidance available for electronic laboratory order interfaces across the ambulatory setting. Implementation guidance that defines the communication (i.e. message structure, data elements, vocabularies) of test orders from an EHR System to an LIS, based on accepted industry standards, can:
 * Improve care delivery and clinical outcomes through the tight coupling of order and result messages;
 * Reduce implementation efforts and costs;
 * Reduce on-going support and maintenance-related activities and costs;
 * Provide an extensible foundation for use in acute care and in-patient settings.

**4.0 Scope**
Develop an IG to support electronic laboratory ordering between an EHR System and a LIS in an ambulatory care setting.

4.1 In Scope

 * Development of a Laboratory Orders IG for ambulatory settings that aligns with the LRI IG and ELINCS Laboratory Orders IG
 * Incorporation of support for the adoption and use of the Test Compendium Framework, i.e., eDOS
 * Development of validation tools to facilitate the evaluation and adoption of the LOI IG

4.2 Out of Scope

 * Non-US laboratory ordering use cases
 * Referral orders placed between laboratories
 * Laboratory orders in the acute setting (EHR System to LIS confined within the hospital system)
 * Non-human samples
 * Laboratory orders specifically for use in Clinical Trials

5.1 Goals

 * To develop an IG that, when broadly adopted by clinical laboratories and ambulatory EHR systems, will obviate the requirement to define a new specification each time an EHR system-LIS orders interface is implemented.
 * Stretch Goal/Consideration: To pursue an approach that enables expansion to consistently support laboratory orders for the acute care and Public Health settings. Note that in the future multiple message structures may be required to support this. This guide does not intend to define the complete framework in the first phase.

5.2 Outcome

 * A laboratory orders interface IG designed to serve as a companion document to the LRI IG.

**6.0 Timeline**
For the most up-to-date timeline, visit the LOI home page.

**7.0 Candidate Standards**

 * HL7 v 2.5.1, V 2.6, V2.7, V2.7.1, V2.8 (pending) messaging standards
 * HL7 Version 2 Implementation Guide: Laboratory Test Compendium Framework, Release 1 (eDOS)
 * HL7 Version 2.5.1 Implementation Guide: S&I Framework Lab Results Interface, Release 1 - US Realm (July 2012)(LRI IG)
 * Logical Observation Identifiers Names and Codes (LOINC)
 * Systemized Nomenclature of Medicine--Clinical Terms (SNOMED CT)
 * Unified Code for Units of Measure (UCUM)
 * International Classification of Diseases (ICD)
 * Current Procedural Terminology (CPT)

**8.0 Stakeholders**

 * Provider Organizations developing/implementing laboratory order interfaces
 * EHR System Vendors developing/implementing laboratory order interfaces
 * Laboratories developing/implementing laboratory order interfaces
 * LIS Vendors developing/implementing laboratory order interfaces
 * Standards Development Organizations (SDO) developing similar implementation guides and enhancing standards to support this implementation guide
 * Health Information Exchanges (HIE) developing/implementing laboratory order interfaces
 * Federal and State Agencies regulating use of Health Information Technology

**9.0 Initiative Activities by Phase**

 * **Phase** || **Typical Activities** ||
 * **Pre-Discovery** || * Development of Initiative Synopsis
 * Development of Initiative Charter
 * Definition of Goals & Initiative Outcomes ||
 * **Discovery** || * Creation/Validation of Use Cases, User Stories & Functional Requirements
 * Identification of interoperability gaps, barriers, obstacles and costs
 * Review of Vocabulary ||
 * **Implementation** || * Creation of aligned specification
 * Documentation of relevant specifications and reference implementations such as guides, design documents, etc.
 * Validation of Vocabulary
 * Development of testing tools and reference implementation tools ||
 * **Pilot** || * Validation of aligned specifications, testing tools, and reference implementation tools
 * Revision of documentation and tools ||
 * **Evaluation** || * Measurement of initiative success against goals and outcomes
 * Identification of best practices and lessons learned from pilots for wider scale deployment
 * Identification of hard and soft policy tools that could be considered for wider scale deployments ||

**Members**

 * Initiative Coordinator****:** John Feikema

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 * Support:**
 * **Name** || **Contact Information** ||
 * Neha Wadekar || neha.d.wadekar@accenturefederal.com ||

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