Hl7 v2 testing

[Emma Darby]

Hi there, 

I am trying to develop an app that will upload test results from a device to a patients EMR. I have not done this before, and HL7 sounds a bit complex, but is this something that I could do? Then test my application with your lab testing tool? Any help is hugely appreciated. Thanks!

Emma

[Taylor, Sheryl L. (Fed)]

Hi Emma,

 

NIST received your inquiry, and we have forwarded it on to a laboratory results interface expert for analysis and response.

 

Thank you,

 

Sheryl

 

National Institute of Standards and Technology

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[Taylor, Sheryl L. (Fed)]

Hi Emma,

 

Per the laboratory results interface (LRI) expert, your ability to develop an app that will upload test results from a device to a patient’s EMR depends on what EMR you want to connect to - that EMR would need to be able to process the LRI message (HL7 Version 2) that your app produces. Currently, LRI is, unfortunately, not widely implemented across EMRs, though the hope is that will change soon.

 

The current NIST LRI conformance testing tool accessible at https://hl7v2-lab-r2-testing.nist.gov/labs-suite-tool/#/home is designed to test HL7 v2 messages for conformance to the different standards. For lab results data exchange, LRI would be the right specification, though the current NIST LRI tool is updated only to the 2016 version of the LRI Implementation Guide (IG).

 

The Association of Public Health Laboratories (APHL) is using the NIST development platform for creating LRI and laboratory order interface (LOI) HL7 v2 testing tools – accessible via the General Validation Tool (GVT) here https://hl7v2.gvt.nist.gov/gvt/#/home under the Tool Scope “APHL”. These tools need to be updated to support the currently published IG releases from 2018; and newer IG versions for both LRI and LOI are to be published soon that support more of the pandemic reporting requirements. Then the plan is that these IGs will be built in the NIST Implementation Guide & Authoring Tool (IGAMT), and those profiles will be published in GVT.

 

Thank you for your question.

 

Sheryl

NIST

[Emma Darby]

Hi Sheryl,

Thank you so much for this information! I believe Epic (which is the EMR I am trying to connect with) does support LRI. They have a standard published on their website for Incoming Ancillary Results (see attached). Epic also has an HL7v2 validator that I just found, which seems to use your public web validator that you have described. I understand that the validator just checks to see if the messages are formatted and written properly. Do you have any tools that will verify that the lab results are inputted correctly as test results in an EMR server? ie. a testing sandbox with a "fake" EMR? Or how do you think it would be best to verify that the code works? Or is that what the General Validation Tool is used for (as opposed to the LRI conformance tool).

Thanks again! 

Emma

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[Riki Merrick]

Hi Emma,

I am confused by your question: Do you have any tools that will verify that the lab results are inputted correctly as test results in an EMR server? ie. a testing sandbox with a "fake" EMR? - what exactly are you asking to test here - that when the app say COVID-19 PCR, that the message put COVID-19 PCR in the right place in the message? Or that the EMR that has received the message properly displays the content?

Or how do you think it would be best to verify that the code works? - what code are you talking about here?

The GVT validates conformance to structural and to some extent vocabulary requirements of the chosen specification - e.g. LRI in the context-free validation tab; for some of our programs APHL has built vocabulary validation for tests and related result values, but that is not normally included in context-free validation.

If there are test cases built - and for LRI that is the case - you can use the context-based validation tab to check for specific values - for example if the test case calls for a LOINC code for a specific COVID19 PCR test, the validator will produce an error, if that is not used - while the context-free validation would only tell you if the code you used followed the LOINC rules for code construction.

Does that help?

Riki

Riki Merrick

Vernetzt, LLC

rikim...@gmail.com

cell: 916.216.0052
skype: riki.merrick

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[Emma Darby]

Hi Riki,

Thank you, that makes sense about the context-free validation versus the context-based validation. What I was wondering is if there is a way to see how the message is actually shown on the EMR screen. That is why I was wondering if there is a "fake" or "mock" EMR that will show the test result after the app sends the results, to verify that it has been received properly. Is there any sort of testing portal like that? Or how do I know how the test result is actually shown on the EMR?

Thanks,

Emma

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[Riki Merrick]

The HL7 specifications are usually about the exchange format, not about the display format. SO even if there was a mock EMR that displayed the results you sent to it, that doesnt mean that other MErs would do it the same way. We did write a Functional Requirements guide for LRI - the rules around what part of the lab result has to be stored, processed, displayed, but I am not sure who has implemented it: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=433

Riki

Riki Merrick

Vernetzt, LLC

rikim...@gmail.com

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[Emma Darby]

Thanks for all of the information Riki. This is all very helpful.

Best,

Emma

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[Emma Darby]

Hi Riki,

I just wanted to ask: is there any sort of testing sandbox for LRI with HL7? Doesn't have to be a "fake" EMR. Just wondering if there is anything else to test with.

Thanks,

Emma

[Riki Merrick]

Only this tool at the moment: https://hl7v2-lab-r2-testing.nist.gov/labs-suite-tool/

Go to ceontext-free tab - select the profile-group and then the applicable profile

then you can paste or upload your test messages (no batch messages)

Riki

Riki Merrick

Vernetzt, LLC

rikim...@gmail.com

cell: 916.216.0052
skype: riki.merrick

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[Snelick, Robert D. (Fed)]

HI Emma,

 

This tool (for LRI, and used in MU certification)  https://hl7v2-lab-testing.nist.gov/mu-lab/ and the tool that Riki pointed may be  helpful. In addition to testing messages it also provides a way to test lab results incorporation (i.e., what should be imported, incorporated, and displayed to the screen). It does provide not a “fake” EMR.  Under the EHR context-based validation navigate to a test step and select juror document to see what lab results are expected to be displayed for a given message (the navigation is a bit different in the tools but you are looking for the juror document). There is documentation for each showing how the testing should occur. It is self-inspection (given this message, this is what the EHR needs to display).

 

Hopefully this helps.

Regards,

Rob

NIST

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[Emma Darby]

Hi Riki and Rob,

These testing platforms are great! The juror document is exactly what I'm looking for -  I will use the juror document to see how the messages show up in an EMR and then use the validation tool to validate my own messages.

Thanks everyone!

Emma

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[Taylor, Sheryl L. (Fed)]

Hi Emma,

 

Please note: the Juror Documents only provide a checklist for WHAT information is to be displayed in the EHR/EMR not HOW, i.e., not the design of the screens or format in which the information is to be displayed.

 

Sheryl

NIST

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[Emma Darby]

Hi Sheryl, 

Thanks for the note - I'll only use it as a checklist.

Take care,

Emma

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