NHS North West Genomics, published by NHS North West Genomics. This guide is not an authorized publication; it is the continuous build for version 0.2.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/nw-gmsa/nw-gmsa.github.com/ and changes regularly. See the Directory of published versions

Inter Laboratory Workflow (ILW)

References

1. IHE Inter Laboratory Workflow
2. IHE Laboratory Technical Framework Supplement Inter-Laboratory Workflow (ILW)

Actors and Transactions

Overview

See Ref 1 for details.

IHE ILW Summary

Modernisation

The current IHE ILW specification relies on HL7 v2.x, HL7 v3, and IHE XDS. Several modernization paths are available, most of which focus on adopting FHIR, updating relevant IHE profiles, and shifting from Clinical Documents (HL7 CDA and FHIR Documents) to IHE QEDm for data exchange.

IHE ILW Modernistion with FHIR

Scenarios

NHS England Genomic Order Management Service FHIR API

• NHS England - Genomic Order Management Service FHIR API a FHIR Workflow based service for managing orders and results at a national level.

NHS North West Children Cancer

See Blood Tests which includes inter-organisation workflows around laboratory testing.

Options

Variations on the basic TLW scenario.

Order Order Placer MUST include Ordering Facility (ODS Code) if the Order Filler is outside the organisation (i.e. ICS Pathology Lab or Regional Genomics Lab). Order Filler MUST respond with a Report Identifier and the Order Identifier (if supplied in the Order) in the laboratory report.

sequenceDiagram
    participant OrderPlacer
    participant OrderFillerGenomics

    OrderPlacer ->> OrderFillerGenomics: Places Laboratory Order (Order Identifier 1. Optional Visit/Spell Number A)
    OrderFillerGenomics -->> OrderPlacer: Returns Laboratory Report (Report Identifier 1 & Order Identifier 1. Optional Visit/Spell Number A)

Orchestrated Order

e.g. Haematology and oncology services

The specialty is responsible for sending a consolidated report to the Order Placer. For both the Pathology and Genomics Orders, the original Order Identifier SHOULD be included in the order (ServiceRequest.basedOn)

sequenceDiagram
    participant OrderPlacer
    participant OrderFillerSpecialty 
    participant OrderFillerPathology
    participant OrderFillerGenomics
  

    OrderPlacer ->> OrderFillerSpecialty: Places Order (Order Identifier 1 & Visit/Spell Number A)
    alt Pathology Diagnostic Testing
        OrderFillerSpecialty ->> OrderFillerPathology: Places Laboratory Order (Order Identifier 2 & Visit/Spell Number A)
        OrderFillerPathology -->> OrderFillerSpecialty: Returns Laboratory Report (Report Identifier 1, Order Identifier 2 & Visit/Spell Number A)
    end
    alt Genomic Diagnostic Testing
        OrderFillerSpecialty ->> OrderFillerGenomics: Places Laboratory Order (Order Identifier 3 & Visit/Spell Number A)
        OrderFillerGenomics -->> OrderFillerSpecialty: Returns Laboratory Report (Report Identifier 2 , Order Identifier 3 & Visit/Spell Number A)
    end

    OrderFillerSpecialty -->> OrderPlacer: Returns (Discharge/Hospital?) Report (Report Identifier 3, Order Identifier 1 & Visit/Spell Number A)

Reflex Order

Is this around cancer? Is similar to above but both Lab and Genomics use the specimen for testing, so the genomic order is raised by the Pathology Lab.

Who has the responsibility for sending the genomic report to the Order Placer?

For the Reflex Order, the original Order Identifier SHOULD be included in the order (ServiceRequest.basedOn)

sequenceDiagram
    participant OrderPlacer

    participant OrderFillerPathology
    participant OrderFillerGenomics
  

    OrderPlacer ->> OrderFillerPathology: Places Order (Order Identifier 1, Visit/Spell Number A and Specimen Accession Number X)
    OrderFillerPathology -->> OrderPlacer: Returns Report (Report Identifier 1, Order Identifier 1, Visit/Spell Number A  and Specimen Accession Number X)
   
    alt Reflex (Genomic) Diagnostic Testing
        OrderFillerPathology ->> OrderFillerGenomics: Places Laboratory Order (Order (Filler) Identifier 2,  Visit/Spell Number A and Specimen Accession Number X)
        OrderFillerGenomics -->> OrderFillerPathology: Returns Laboratory Report (Report Identifier 2, Order Identifier 2, Visit/Spell Number A and Specimen Accession Number X)
    end
    OrderFillerPathology -->> OrderPlacer: Returns Report (Report Identifier 2, Order Identifier 1, Order Identifier 2, Visit/Spell Number A  and Specimen Accession Number X)

Sub Contact

Genomic Lab sub contracts to another Genomics Lab for testing.

For the Sub Contracted Order, the original Order Identifier SHOULD be included in the order (ServiceRequest.basedOn)

sequenceDiagram
    participant OrderPlacer

    participant OrderFillerGenomics1
    participant OrderFillerGenomics2
  

    OrderPlacer ->> OrderFillerGenomics1: Places Order (Order Identifier 1, Visit/Spell Number A and Specimen Accession Number X)

    alt Sub Contracted Genomic Diagnostic Testing
        OrderFillerGenomics1 ->> OrderFillerGenomics2: Places Laboratory Order (Order Identifier 2, Visit/Spell Number A and Specimen Accession Number X)
        OrderFillerGenomics2 -->> OrderFillerGenomics1: Returns Laboratory Report (Report Identifier 2, Order Identifier 2, Visit/Spell Number A and Specimen Accession Number X)
    end

    OrderFillerGenomics1 -->> OrderPlacer: Returns Report (Report Identifier 1, Order Identifier 1, Visit/Spell Number A  and Specimen Accession Number X)