Hi,
We have a project that's working on referring lab orders from a lower level lab up to the national laboratory for CD4 viral load counts. The national lab processes the test and returns a result back to the lower level lab. The lack of standard internet connectivity at the lower level labs will cause a number of failures on both levels. Because of this, I'm scoping a push/pull mechanism that utilizes a centralized broker to store the orders and requests at the national level. In this case, the local labs would put the orders in a national broker/queue that would be read by the national lab on a regular basis. The same would happen for the lab results where the national lab would put results in the broker and the local clinic would download those results when internet connectivity was available.
The national broker would have to have a number of features:
- access controls
- audit capabilities to see what's been pushed and pulled, but we would also want point of service systems to check that a specific order was picked up by the national lab
- tracking the last time the clinic accessed the queue (from my previous post)
Questions:
- Are others working on this problem? If so, has it been solved with OpenHIE?
- Is this problem appropriate for an HIE, or should another mechanism be considered?
- I know of the lab order and request HL7 profile, which defines the messaging format, but I don't know if IHE or other standards bodies have addressed environments where the internet goes out frequently. Are we treading new ground?
- I see that the mechanism of pushing and pulling information is core to the HIE, especially with the SHR. Though I need to solve this for lab orders/requests, this problem feels like it could be solved by a generic messaging service. Do others agree? Has anything like this been developed?
Thanks,
Craig