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  • List Implementation Needs/Preconditions/Assumptions

  • Define Timeline Milestones/Phases/Scope

    • List Goals/Achievements/Measures for each Milestone/Phase/Stage

    • Define metrics to know how you know you’ve met or missed the mark.

  • Define Interoperability

    • Semantic

    • Syntactic

    • What is the goal for each milestone/phase?

  • Provide Status Update of existing SHIELD Pilots

  • Proposal

    • Phase 0: Assessment of current state

      • Information System Use

        • How many labs use an electronic system (LIS, LIMS, EHR, other portal) to build laboratory orders, results, values?

        • How many labs use paper reporting?

        • How many labs use fax/phone reports?

        • Goal: Get all those use non electronic reporting to electronic reporting.

          • How achieved? Policy? Incentives to purchase/install system? Funding to help labs build, etc.

          • How measured? Within a year, 50% increase with 100% increase in 2 years? What is the gap and how filled?

      • Information System functionality

        • Does Information system have basic lab/informatics/coding/messaging functionality?

          • Codesystems

            • LOINC, SNOMED CT,

            • Does information system support functionality for mapping lab orders and results to current LOINC releases and maintenance

            • Does information system support functionality for mapping qualitative result values, specimen types, specimen sources, organisms, collection procedures, etc. to latest (US or Intl) versions of SCT and maintenance

            • Other code systems: ICD, UCUM, CPT, etc.

            • Goal: Have all LIS/EHR/ information systems with code system support (by when)? How measured? (certification process like EHRs or other measure)?

          • Capability to build/support discrete orders and results and result values for all lab test info

            • Current State: Some LIS/LIMS vendors are unable to support creation of discrete orders and results for all lab data. Some have “workflow items” that are added on to support billing and documentation, but are unable to be mapped to LOINC or SCT as they are not built as orders, results, values. Others have capability for test orders, but they are “suppressed” and not released external to LIS/EHR. More common in microbiology and blood bank areas (i.e. micro antibody susceptibility panel orders, blood bank antigen testing). Will take time to get functionality, so may not be first phase of LIVD implementations.

            • Goal: get all lab data discretely captured, reported (origin, receipt in, sent out).

            • How achieved/measured? Vendor functionality (certification?) Measure of test data that is build discretely as orders/results

          • Discretely captured lab data (i.e. non text blob, pdf reports)

            • Current State: Fair number of lab results/report of record are still not discrete, especially those received from labs via pdf or fax or paper which are scanned/stored as pdfs. At best, these pdfs can support a single LOINC code (path report, lab report), are not very computer processable or semantically interoperable and information therein requires manual work/reading, etc.

            • Assess current state of how much lab data is not very usable as non discrete. Metrics/definitions needed. Assess what is discrete and not encoded (i.e. CAP Cancer Protocols, Genomics reports, some micro/esoteric testing). Assess what % is codified (i.e.) and not codified (individual reports or overall orders/results/values)

            • Goal: Work to make % improvements on discretely capturing and reporting data (some is discretely captured, but still reported as text blob/pdf) in all information systems. Goal : Work to make % improvements on encoding discrete data (precondition here).

            • Note: Won’t be 100%, but perhaps we can get to 70% overall. May want to assess by lab area (chem, hem, micro, blood bank, genomics, cytology, pathology, etc.) as will vary by section. Chem and Hem may get closer to 90% goal, but genomics might be 20% now (harder to get discrete and codify). Pathology may have good discrete coverage, but not as much with encoding (as work in progress). Goals should be realistically achievable. Also some lab data may never be encoded (i.e. no LOINC, not conducive).