Standards Benefit the New Brunswick Lab Repository. Canada Health Infoway 2014

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1 Standards Benefit the New Brunswick Lab Repository Canada Health Infoway 2014 Lorie Carey & Marion Long November 27, 2014

2 Do We Need a Central Lab Repository? Improving patient care 1 Between 60% and 70% of medical decisions draw upon in vitro diagnostic test results. Diagnostics have a significant impact on the quality of care provided: detecting and diagnosing disease more rapidly and at an earlier stage, even before symptoms occur, determining disease risk earlier, choosing more targeted, effective, and often less invasive treatments, monitoring treatment to effectively manage chronic diseases, estimating patient prognosis Canada Health Infoway

3 Goal All Lab Results Accessible Electronically Canada Health Infoway 2014

4 The Role of Standards Anyone else confused by elevator buttons? 1 st floor please Canada Health Infoway

5 Why Standards? Canada Health Infoway

6 Which Standard? Like the elevator buttons, often there are subtle differences between lab tests from different systems To provide meaningful comparability between tests, Canada Health Infoway looked to international standards in Adapted LOINC (Logical Observations Identifiers Names and Codes 1 ) as the standard Canadianized LOINC to create pclocd (pan- Canadian LOINC Observation Code Database) Published in May 2007, CAS approved Canada Health Infoway

7 What is LOINC, Why is it Important? LOINC is a terminology that provides universal names and identification codes to standardize lab tests Each LOINC record corresponds to a single test result or panel Receiving medical systems cannot fully understand the lab tests they receive from multiple lab systems unless they adopt each sender s laboratory tests or invest in the work to map each lab s tests to their internal code system Used beneath the covers in electronic systems to standardize tests in lab Canada Health Infoway 2014

8 Laboratory Test Comparisons This is what is typically reported Lab A Test Name ASOT Measures: Streptolysin O Ab Specimen: Serum Method: Latex Agglutination Scale: Quantitative Example result value: Titer of 1:40 LOINC Code Lab B Test Name ASOT Measures: Streptolysin O Ab Specimen: Serum Method: Latex Agglutination Scale: Quantitative Example result value: U/mL LOINC Code Canada Health Infoway 2014

9 Evolving pclocd Getting Across Canada: Knowledge sharing Early adopters shared their tools and their lessons learned Provinces listened and benefited Flexibility to change Implementers provided feedback to Infoway based on their needs Infoway responded by modifying pclocd to meet implementer needs Translation Quebec actively engaged in translating LOINC to Canadian French Infoway developed the process 9 Canada Health Infoway 2014

10 Progress of pclocd Implementation Between pclocd was implemented across Canada Saskatchewan was the first province 2008 New Brunswick, British Columbia and Quebec all kicked off their Lab projects Manitoba Lab project initiated, Infoway translated pclocd to Canadian French 2009 developed pan-canadian Guiding Principles and Rules for lab viewer names Ontario, Newfoundland and Alberta Lab projects began Canada Health Infoway

11 What pclocd Provides A standard view of the elevator buttons An implementable standard, packaged and ready to go for Canadians A process to support the ever evolving lab environment, new Canadian codes are requested and created regularly By using pclocd, disparate lab tests can be compared, trended, shared, understood Canada Health Infoway

12 Where Is It Used Today? Lab repository Project MB Yukon Lab Project Lab repository project QC Lab repository project NL PLIS project BC Lab repository project AB SSLRR project SK echn Lab Repository ON OLIS Lab Repository ON OPOR project NB Canada Health Infoway 2014

13 Marion Long New Brunswick Lab Repository I am pleased to turn the microphone over to Marion Long from New Brunswick Marion will share with you some of the value-add, benefits and advantages they have realized by implementing this pan-canadian standard Canada Health Infoway

14 Standards Benefit the New Brunswick Lab Repository

15 Standards Benefit the New Brunswick Lab Repository NB Population: 754,524 (Stats Canada) Number of Zones: 8 Number of Laboratories: 20 Disciplines in the EHR: - Gen Lab (Chemistry, Challenge, Hematology, Coagulation, Serology. Molecular Genetics) - AP & Cytology EMRs: 56 clinics

16 Standards Benefit the New Brunswick Lab Repository Benefits Enhanced Patient Care: Patients cross jurisdictions for care (Oncology, Cardiology, Urology) Improved turn around times: Referred tests available in real time Standardized Terminology: LOINC Viewer Names Bilingual Service: All Viewer Names are translated Data Quality Program Opportunity for the LIS Coordinators to meet as a Provincial group.

17 English View

18 French View

19

20 Cumulative Report

21 Graphic Display

22 EMR Access to the EHR

23 EMR Access to the EHR

24 Tests Mapped to LOINC Codes

25 Add Change Request

26 Mapped Test in NBAMA

27 Testimonials As I was reviewing my morning reports, I noticed that one of my patients had been admitted to CCU with congestive heart failure. I looked on our local MEDITECH system and determined that she was no longer an inpatient. The most logical conclusion was that she was transferred to the NB Heart Centre. I logged on to the provincial EHR and she came up on My Admitted Patients list. I was able to see she was, in fact, an inpatient at the Saint John Regional Hospital with a diagnosis of myocardial infarction. I reviewed the available laboratory data and was subsequently pleased to conclude she was stable. It was great to be able to obtain this information so efficiently. I am now benefiting from our hard work over the past three years. Dr. Luc Arsenault, MD Miramichi, New Brunswick

28 Canada Health Infoway 2014 Thank you

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