LRI+-+Appendices

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Appendix A: List of In Scope Tests
This list was created using the list of LOINCs provided in the 2.5.1 Implementation Guide: Orders & Observations; Ambulatory Care Lab Result (ELINCS), Release 1 as a basis. Some codes from the ELINCs list were removed because they were deprecated, erroneous or not applicable to use in the US. Anatomic pathology, cytology, microbiology, virology and serology tests, which were identified as important to ambulatory care, were added.

Representing the National Library of Medicine, Dr. Clem McDonald, filled in the remaining top 300 tests based on laboratory result data obtained from Indiana Healthcare, United Healthcare and a Boston provider group (marked in green). Dr. McDonald also provided guidance on LOINC terms that should be modified or removed from the list.

The list of tests has been organized by order panel or, for micro related tests, by target organism for easier readability. The LOINC terms included here are considered examples only – though they may be the more common LOINC terms, each lab needs to be sure to map their own tests to the most appropriate LOINC, even if it is NOT on this list. This is NOT an exclusive list of LOINC terms – ANY valid LOINC should be accepted in data exchange projects based on this specification.

The Targeted Format column does not show report format designations for all test rows – the idea is to show that we cover each suggested format within the test list. However, please be aware that since all of the tests on the list have associated LOINC codes, there are no included examples that represent B reporting formats (use of laboratory specific local terminology only).

[|ONC_InScopeTests_ListofTests_DRAFT_v8_041111.xls]

**Appendix B: Related Use Cases**

 * ONC/AHIC: Public Health Case Reporting
 * ONC/AHIC: Biosurveillance (Visit, Utilization, and Lab Result Data)
 * ONC/AHIC: Electronic Health Record (Laboratory Result Reporting)
 * ONC/AHIC: General Laboratory Orders
 * ONC/AHIC: Order Sets
 * NHIN: Biosurveillance Use Case
 * NHIN: EHR Lab Scenario Use Case Requirements
 * NHIN Direct: A provider EHR orders a test
 * NHIN Direct: Laboratory reports test results for some specific conditions to public health
 * NHIN Direct: Laboratory sends lab results to ordering provider
 * HIMSS: Biosurveillance - Monitoring and Detection
 * HIMSS: Cancer Reporting - Prostate Cancer, Chronic Lymphocytic Leukemia
 * IHE: Publishing of lab summary at discharge
 * IHE: Publishing of patient report into the regional patient health record
 * IHE: Ambulatory provider shares a laboratory report
 * IHE: Private and/or public laboratory publishes all its reports automatically
 * IHE: Health care institution produces a cumulative laboratory report of test performed on the patient
 * IHE: Public health laboratory shares report in a regional repository
 * ELINCS: Reporting of Laboratory Results to EHR Applications

Appendix C: Previous Work Efforts Related to Laboratory Results

 * The Healthcare and Interoperability Standards Panel (HITSP) Interoperability Specification (HITSP/01): The Electronic Health Records Laboratory Results Reporting Interoperability Specification defines specific standards to support the interoperability between electronic health records and laboratory systems and secure access to laboratory results and interpretations in a patient-centric manner.
 * Healthcare and Interoperability Standards Panel (HITSP) Laboratory Message Component (HITSP/C36): The Laboratory Result Message Component describes the use of a constrained Health Level Seven (HL7) Version 2.5.1 ORU – Unsolicited Observation Message for electronic laboratory results reporting.
 * EHR-Laboratory Interoperability and Connectivity Specification (ELINCS) HL7 Version 2.5.1 Implementation Guide: Orders and Observations; Ambulatory Laboratory Results (ELINCS), Release 1.
 * HL7 Version 2.5.1. Implementation Guide: Order and Observations; Interoperable Laboratory Results Reporting to Electronic Health Record (EHR), Release 1
 * Healthcare and Interoperability Standards Panel (HITSP) Laboratory Message Component (HITSP/C80): The Clinical Document and Message Terminology Component defines the vocabularies and terminologies utilized by HITSP specifications for Clinical Documents and Messages used to support the interoperable transmission of information
 * HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm)

Appendix D: Privacy and Security Assumptions
Security attributes includes capabilities needed to establish trust between systems, provide confidentiality while in-transit, ensure authenticity of the data, and ensure that only authorized individuals have access to the data. Table 1. Common Transactions. These are not displayed as part of the sequence diagram
 * **Feature** || **Feature Applicability** ||
 * Audit Logging || X ||
 * Authentication (Person) || X ||
 * Authentication (System) || X ||
 * Authorization (Person) || X ||
 * Authorization (System) || X ||
 * Data Integrity Checking || X ||
 * Error Handling || X ||
 * HIPAA De-Identification ||  ||
 * Holding Messages || X ||
 * Non-repudiation || X ||
 * Pseudonymize and Re-Identify ||  ||
 * Secure Transport || X ||
 * Transmit Disambiguated Identities || X ||
 * User Login || X ||

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