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Question

Response

Can I put two different results for the same test in one HL7 message?  (e.g., Can I send two different creatinine results in one HL7 message?)

No.  An ORU^R01 test result message can only have one Filler Order Number (FON) associated with it.  Each unique FON can only have one value for a single test ID.

PKB doesn't accept that two different results for the same test ID can be linked to one FON because if you go on to send another HL7 message to update just one of those results -- how would PKB know which to update?  That single FON is linked to two of the same thing and PKB wouldn't know which result should be updated.  

Is it possible for tests to be delayed based on the authorisation date provided in the HL7 message?

No, delays are always applied from the date supplied for the observation timestamp in OBX 14.1 (or OBR-7.1 if OBX 14.1 is blank).

Delaying based on the process of reporting is not considered best practice because the disease progresses without waiting for the process of reporting, and the clinical safety risk of the patient not seeing their report goes up every day the report release is delayed.

If there are concerns about how quickly some test results might be released to patients, then consideration should be given to how the days to delay by is calculated before it is sent in the HL7 message.

If we put a delay on a result, does it mean that PKB won’t process it?

No, PKB still processes the result and the patient is notified.  However the patient (or carer) can not see the content of the result in the UI, only that they have a result and when it will be released to them.

Can clinicians / professionals see delayed results?

Yes, delays to displaying results do not apply to clinicians.

What will PKB do if we effectively resend an unchanged result but with a different (longer) delay in OBR:13?

If you update the delay days for a previously sent result (and nothing else other than MSH), then we'll apply the delay using that changed value as it relates to the Observation timestamp.

The UI will also display to the user that a "correction" has been made to the result

If we’re sending LOINC-mapped results, are the units we send in the HL7 message important?

Yes, the units sent in with LOINC-mapped results are very important.  

1. if you tell us the units you are using for each test, we’ll make sure we can support those units for that test. We match on LOINC code and unit, but do need to map each possibility.

2. Units need to match our expectation exactly

3. If a LOINC has multiple unit possibilities, we need to map each one. Each combination is graphed separately in PKB

4. If we receive a LOINC code and unit combination we don't have mapped we treat as a result that's not LOINC mapped

5. Our matching is done on string matching, so units must match exactly (including CAPS use).

How can we assure that the LOINC code and units mapping is correct? 

All lab panels, when viewed in the UI will have the Trusts name in brackets after the panel name if they are NOT LOINC mapped.

If they are LOINC mapped, the Trust name will not appear and the lab name would match the PKB name rather than the Trusts name for that test.  You can view panels in the UI by going to Health > Tests > make sure you click the 'trends' option to see panels.

Alongside this the Lab Tests Online link should only link to the correct page if the test has the correct LOINC code attached (regardless of units matching which is a separate issue).

When I send a LOINC coded result, can I change the display name or the panel the result is displayed within in PKB?

No.  When sending LOINC coded results, the display name and the panel in which it is displayed are both applied by PKB.

Can we send in results so that they are mapped to something other than the General Health privacy label?

There are two places within the ORU message to set the privacy label associated with the results:
PV1-10 (hospital service code) and OBR-4.1 (order service code).  The hospital service and order service codes can be mapped to specific privacy labels in PKB.  You will need support from the PKB integrations team to have this configured.

If a mapped value is supplied in both PV1-10 and OBR-4.1, then the hospital service code privacy label “wins” and the privacy label associated with the hospital service code supplied in PV1-10 is applied to the results in the message.

When will patients receive email notifications?

Patients will receive an email notification when a new test result is sent in for them.  However, PKB sends a maximum of one notification a day for updates to a few data types, including test results.  See the manual for further details.

What is autocreate?

If auto create is enabled (configured by PKB against the organisation), a patient demographic record will be created from the PID detail in the ORU message where an existing patient record can not be found by matching the identifiers provided. (Assuming PID details conforms to minimum requirements.)

Why is sending a reference range important?

The high / low reference range is plotted on the result’s graph in PKB alongside the patient’s actual result for the test.  This allows the patient to know where they sit in the target reference range.  

What is a fully (single) textual report in PKB?

PKB considers a fully textual report to be have been sent when the following are true:

• There are 1 or more OBX segments, which together contain at least 2 lines of text (note that supplying ~ denotes a line break)

• Each OBX segment declares a textual data type (TX, FT, ST)

• All the OBX segments have matching test IDs (OBX-3.1 and OBX-3.3, case sensitive)

If all of those points are true, then

• The OBX segments will be combined into the lab Comments section.

• OBX-3.3 (test coding system) will be overridden by OBR-4.3 (service coding system)

• OBX-3.1 (test ID) will be overridden by OBR-4.1 (service ID)

Why are the values I sent for OBX-3.1 and 3.3 not showing when I send in a textual result?

If your report conforms to the criteria of being a fully (single) textual report, then those values are replaced by the ones supplied in OBR 4.1 and 4.3 respectively.

How can a result be deleted from a patient record?

To delete a specific result from a patient record, an ORU HL7 message is required that contains the Filler order number (as derived from ORC-3.1 or OBR-3.1 ) of the Report that the result was sent within, with the Result status (OBR-25.1) set to R.

• This will delete ALL results sent as part of that report

The report then needs to be re-sent but containing only the results you want to have displayed.

In summary:
Delete the report (where it includes a result that should not be there) and send in the report again, containing the results that should be included.

Does PKB support HTML for HL7 lab results?

No.