# Order Laboratory Test

Electronic Medical Records (EMRs) systems can send an electronic lab order to a laboratory information system (LIS).

| **Workflow Maturity**         | <p><img src="https://lh6.googleusercontent.com/Kxkqfa92YGW3mIOmWio0Twi4YLMA92z6mL1MuFzkx4AWS5CX5zbzWid5z4p2W-e6O66llKpaU0r6lzwyXfhbIiWmkVEuPDy6stX5x5L8uC2DkEXs6qUFX-7xxXTlb9hbkg" alt=""></p><p><strong>Newly Defined</strong></p> | <p></p><ul><li><strong>Workflow is defined and ARB approved</strong></li><li><strong>Initial implementations are being implemented</strong></li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                    |
| ----------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
| Standards                     |                                                                                                                                                                                                                                     | <p></p><ul><li>FHIR R4 search on Task, DiagnosticReport, ServiceRequest or Patient resources</li><li>FHIR R4 bundle search response</li><li>FHIR R4 Workflow</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                   |
| Assumptions and Prerequisites |                                                                                                                                                                                                                                     | <p></p><ul><li>The EMR and LIS are trusted applications known by the IOL </li><li>The IOL supports node authentication, audit tracking, and rerunning of failed transactions</li><li>The SHR adheres to OHIE specification</li></ul>                                                                                                                                                                                                                                                                                                                                     |
| Actors                        |                                                                                                                                                                                                                                     | <p></p><ul><li>EMR - The electronic medical record system that captures the patient and order information and sends the electronic order to the LIS</li><li>LIS - The laboratory information system that pulls order information, processes orders, updating statuses and generating results sets</li><li>IOL - The interoperability layer that secures and orchestrates the exchange of information (see OHIE Interoperability layer)</li><li>SHR - The shared health record that serves as a centralized data store for patients’ longitudinal health record</li></ul> |

## **Interaction Description**&#x20;

![](https://lh6.googleusercontent.com/rmStLcHds3HOuCnVpcLYt6-3RIRWbR2jCa-s7jsKWQnvcdXo37rxEM23xYKsid4Qz6lVa2A2t2rZ_9742sX_mVGAQ5htfn9BYVcCRV0-06PPx--UAi6iXcx1Mr7blm6fqQ)

| **#** | Interaction                        | Data                                                                                                                                                                                                                                                                                                                                                                                                                | Transaction Options                                                                                                                                                                                                                                                  |
| ----- | ---------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| 1     | Create Lab Order                   | The order save generates a FHIR R4 Task Resource ([see example here](https://docs.google.com/document/d/10cEBED1abA2s8LWFzLDWldv4j25pByQF8K2oZfhHB24/edit?ts=5f245ba3#heading=h.xk6hg1i1g2xp))                                                                                                                                                                                                                      | Alternatively, the order save could generate a FHIR R4 ServiceRequest Resource for direct transmission.                                                                                                                                                              |
| 2     | Send New Lab Order                 | FHIR Task bundled order is sent to the IOL and consists of a FHIR R4 Task Resource and a referenced FHIR R4 Patient Resource ([example](https://docs.google.com/document/d/10cEBED1abA2s8LWFzLDWldv4j25pByQF8K2oZfhHB24/edit?ts=5f245ba3#heading=h.j3gsupx1n06l)). Task status is aligned with the FHIR workflow communication pattern found [here](https://www.hl7.org/fhir/workflow-communications.html#12.6.2.1) | <p>FHIR R4 bundle (<a href="https://docs.google.com/document/d/10cEBED1abA2s8LWFzLDWldv4j25pByQF8K2oZfhHB24/edit?ts=5f245ba3#heading=h.jhmys02ttr9r">example</a>)</p><p>Alternatively a FHIR R4 ServiceRequest and Patient Resource bundle could be sent<br><br></p> |
| 3,4   | Send New Lab Order                 | Bundled order is routed through the IOL to both the SHR and the LIS                                                                                                                                                                                                                                                                                                                                                 | FHIR R4 bundle ([example](https://docs.google.com/document/d/10cEBED1abA2s8LWFzLDWldv4j25pByQF8K2oZfhHB24/edit?ts=5f245ba3#heading=h.jhmys02ttr9r))                                                                                                                  |
| 5     | Save Order and Update Order Status | FHIR R4 Task Resource Status is updated locally to either rejected or accepted. A FHIR R4 ServiceRequest Resource ([example](https://docs.google.com/document/d/10cEBED1abA2s8LWFzLDWldv4j25pByQF8K2oZfhHB24/edit?ts=5f245ba3#heading=h.dq3fj8djmi9i)) is created for order processing with a reference to the associated task. EMR test requests and LIS orders are matched based on LOINC codes.                  | Alternatively, a ServiceRequest with a link to the referenced ServiceRequest could be populated.                                                                                                                                                                     |
| 6     | Send Order Update                  | Update Task Resource Status from \[5]   is sent to the IOL                                                                                                                                                                                                                                                                                                                                                          | Alternatively, this could be an update to a FHIR R4 ServiceRequest resource                                                                                                                                                                                          |
| 7,8   | Send Order Update                  | IOL routes the updated FHIR R4 Tasks to the SHR and the EMR                                                                                                                                                                                                                                                                                                                                                         | See transaction options \[6]                                                                                                                                                                                                                                         |
| 9     | Update FHIR Task Status            | FHIR task status updated locally                                                                                                                                                                                                                                                                                                                                                                                    | See transaction options \[6]                                                                                                                                                                                                                                         |

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