NHS North West Genomics
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NHS North West Genomics, published by NHS North West Genomics. This guide is not an authorized publication; it is the continuous build for version 2.0.3 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

Order Results Management [LAB-3]

Referenced Standards

Scope

It transmits the observation results from the Order Filler to the Order Result Tracker, when a result is acquired, clinically validated, modified, or deleted at the Order Filler level.

EIP - Document Message

Actor Roles

Regional Order Results management [LAB-3]Order Filler Genomic Laboratory Hub (GLH) LIMSIntermediary NW GLH Regional Orchestration Engine (RIE)Order Result TrackerHL7 v2 MessageORU_R01HL7 v2 MessageORU_R01HL7 FHIR MessageLaboratory Result R01(un)structured(or structured report)(un)structured(or compositionHL7 EU Laboratory Report)

Regional Order Results management [LAB-3] Component Diagram


Workflow

Workflow

Workflow


This is the most widely used method for exchanging laboratory reports and is based on the HL7 v2 ORU_R01 message. Currently, many NHS trusts and laboratories use custom implementations of this standard, which are adapted via Trust Integration Engines (TIE). To reduce integration costs and enhance regional interoperability, we propose developing a regional standard for ORU_R01. This will build upon the Digital Health and Care Wales - HL7 ORU_R01 2.5.1 Implementation Guide (as NHS England has not issued equivalent guidance) and incorporate elements from:

Reports will be shared in PDF format, potentially limited to regionally placed orders (supported by complementary integration methods).

The regional ORU_R01 design is not specific to genomics and can be reused across the six regional diagnostic networks (including imaging and pathology).

Traditional WorkflowTraditional WorkflowOrder PlacerOrder FillerOrder PlacerOrder FillerLaboratory Order O21IHE LTW LAB-1Perform TestoptLaboratory Report (preliminary) R01IHE LTW LAB-3Laboratory Report (final) R01IHE LTW LAB-3

IHE LTW Laboratory Testing Workflow


Workflow Steps

  • Order Placement
    • The Order Placer sends a Laboratory Order O21 (IHE LTW LAB-1) to the Order Filler.
  • Test Execution
    • The Order Filler performs the laboratory test (internal step).
  • Optional Preliminary Report
    • The Order Filler may send a Laboratory Report (preliminary) R01 (IHE LTW LAB-3) back to the Order Placer.
    • This is marked as optional (opt) in the diagram.
  • Final Report
    • The Order Filler sends the Laboratory Report (final) R01 (IHE LTW LAB-3) to the Order Placer.

Message

The following messages are used to support creation and updating of the Genomics Test Report composition

Message Purpose EIP Type
Laboratory Results The results for a laboratory-order request. Document Message
Laboratory Results
Order FillerIntermediaryOrder Result TrackerOrder FillerIntermediaryNW GLH Regional Orchestration Engine (RIE)Order Result TrackerPerform TestsWrite Test ReportSend HL7 v2 MessageUnsolicited Observation ORU_R01Validate messagealt[Successful validation]Response HL7 v2 Message AA Application AcceptEither option can carry a compositionHL7 EU Laboratory Reportopt[HL7 FHIR Message]Transform HL7 v2 to FHIR MessageSend HL7 FHIR MessageLaboratory Results R01Response HL7 FHIR Message[HL7 v2 Message]Send HL7 v2 MessageUnsolicited Observation ORU_R01Response HL7 v2 Message[Unsuccessful validation]Response HL7 v2 Message AE Application Error

Regional Order Results management [LAB-3] Sequence Diagram