Note: While this use case describes the entire workflow from ordering to reporting, the scope of this Alberta eOrder Laboratory FHIR Messaging Specification is from EMR to CII ONLY (i.e. sending new, update, and cancel order messages from EMR to CII)

Use Case: Lab Minimum Viable Product (MVP)

Provider placing an order and order being fulfilled by Alberta Precision Laboratories (APL)

Description

Health Care Provider sends a lab order request electronically through their community EMR and gives a paper requisition to the patient. The patient visits an APL location to get the lab order request fulfilled.

Notes

The provider initiates a lab test order within their Community EMR using standardized test codes sourced from the Connect Care Beaker Lab Order Catalogue. This order is transmitted as a FHIR message to Alberta Health’s Community Information Integration (CII) platform. A paper lab order summary will also be generated and handed to the patient. CII validates that the FHIR message is structured correctly, and key data is provided correctly (e.g., appropriate test code is used). CII then queries the Provincial Client Registry (PCR) to validate and augment patient identity data and ensure required information for the ordering provider is received. Within Connect Care, the order flows through Bridges and is processed by Beaker, the laboratory module. Once the patient presents at the APL location for testing and collection, then the lab tests are completed.

Scenario

Dr. Patel sees her patient, Emma, for ongoing fatigue and suspects an iron deficiency. Dr. Patel initiates a lab test order for a ferritin test using her Community EMR. The EMR pulls the appropriate standardized test codes from the Lab Order Catalogue. Once submitted, the order is transmitted electronically as a FHIR message to Alberta Health’s CII platform. In parallel, the system generates a paper lab order summary, which Dr. Patel hands to Emma to take with her to the lab.

CII validates that the FHIR message is formatted correctly. It automatically queries the Provincial Client Registry (PCR) to validate and augment Emma’s identity and confirm the data in Dr. Patel’s orders. CII also validates that the appropriate lab test code was submitted. The validated order is then routed into Connect Care, where it passes through Bridges and is received by Beaker, the lab module responsible for processing lab orders. Once the electronic order has been received and processed by the Lab, an electronic order status message is sent back to the EMR indicating the status of the order received.

The following day, Emma visits her nearest Alberta Precision Laboratories (APL) location and provides a blood sample. Once collected, the sample is processed, analyzed, and the results are verified and released.

Participants

Actors/People System
Requesting Healthcare Provider Community EMR
APL Connect Care (Laboratory Information System - LIS)

Pre-conditions

  • A patient visits a community provider, and provider creates a lab order via Community EMR.
  • The Requester Source system has the ability to submit lab orders in the prescribed format.
  • Patient information is validated and augmented by CII by querying PCR.
  • The Connect Care LIS system has the ability to receive and respond to lab orders in the prescribed format.

Primary Flow

abeorderlab-mvp-primary-flow

  1. The provider initiates the lab order process by entering the required test orders into their Community Electronic Medical Record (EMR) system.
  2. A paper requisition is printed and handed to the patient. This serves multiple purposes:
    • Provides the patient with instructions and reminders for submitting lab specimens.
    • Acts as a reference tool for laboratory personnel to locate the electronic order in Beaker and validate its details.
  1. Functions as a fallback in case the electronic order (eOrder) fails to transmit to Connect Care.
  1. The EMR generates a FHIR message containing all lab orders for the patient. This message is transmitted to the Community Information Integration (CII) platform.
  2. CII processes the incoming FHIR message validating that it is formatted correctly, has the appropriate code, and enriches it by appending patient identifiers retrieved from the Provincial Client Registry (PCR).
  3. CII converts the FHIR message into HL7V2 ORM (Order) messages and forwards them to the Alberta Health Services (AHS) Integration Engine.
    • One ORM message is generated for each individual test included in the FHIR message.
  4. The AHS Integration Engine routes the transformed electronic lab orders (ORM messages) to Connect Care.
  5. Upon successful receipt of the lab order, Connect Care issues an ORM status update via the AHS Integration Engine. This update includes both Placer and Filler identifiers for the eOrder.
    • Accepted lab orders become visible to the patient within MyAHS Connect as pending orders.
  6. The AHS Integration Engine transmits the status update message to the eDelivery platform.
  7. eDelivery deposits the status update in the clinic’s secure SFTP (Secure File Transfer Protocol) folder. The provider’s Community EMR retrieves the message from this folder.
    • The EMR processes the status update as a silent notification (i.e., without user interruption).
  8. After completion of the lab tests, results are sent to the AHS Integration Engine.
  9. The AHS Integration Engine forwards the lab results to eDelivery, which then deposits them into the clinic’s SFTP folder.
  10. The provider’s Community EMR accesses the SFTP folder and pulls the lab results into the system for provider review.