OpenMRS & lab data access/transfer

Last Friday I delivered a presentation on eHealth to one of the largest teaching hospitals in Sydney. The department I presented in is aligned with Enrico Coiera’s unit at the AIHI. The whole presentation was one of the most vigorous and interactive that I have ever performed.

The following text is from the head of Pathology regarding OpenMRS. These comments were prefaced with his statement “who in the OpenMRS group should we invite here to help us?” Any responses to Dr Graham Jones questions (in italics)will be valued enormously.


Many thanks for Friday - I spent a bit of time later on looking up OpenMRS and FHIR with Graeme Grieve. To be honest I am not much wiser (a bit above my level). I am of course viewing the issues with a pathology focus, but with the concept that this should be easiest part of medicine to handle with compuetrs (described by HEHTA as “low hanging fruit”) as the data is already digitised and the concepts (eg serum sodium concentration) are reasonably standard.

Starting points:

I absolutely agree with your basic tenets - we are in the information game (perhaps even more so in pathology - creating and supplying information is ALL we do). Next - IT is the only way we can harness the information and change outcomes. Next again - we can only know about the size of problems and whether we are helping with data - again an outcome with IT at its core.

Your examples on Friday, the excitement from experts on line about FHIR - truly inspirational.

BUT: In practice:

Locally we are grinding along installing a new lab IT system - hard work, many hours, many people many dollars (and many error requiring fixing and fixing again) - only to do what we already do now! (but with some hope of modest gains).

Despite many hours of work in the College of pathologists standardising LOINC codes, test names, units etc. Michael Legge being the leader (I play a small role) - I have no faith that this is being brought into practice at a significant rate to help patients (not actually to even bring new things to health care, just remove some impediments to doing what we do now (ie this should help with patient safety and reduce confusion for doctors).

I cannot, at this time, reconcile the promise of health IT and the practical difficulties.

Now to try and recall my scrawl - I may need to see a copy. Very much from memory it may have been the following fairly simple things:

  1. Be able to send pathology test results from one computer system to another in a robust and reliable manner. (I think this goes under the heading of interoperability). At least common LOINC codes would be a great start.
  2. *Agree on test names, units, perhaps significant figures, reference intervals etc. (this may not have been point 2).
  3. I think point 3 was a method to flag whether results for the same test from different labs (or using different methods) can be combined “on the same line” in a pathology report.

These items seem so trivial in comparison with the major things we need to improve but are at least some building blocks for progress.

On another issue, does OpenMRS make use of UCUM compliance for units to facilitate calculations?

With best wishes, Graham

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Thanks, Terry, This is an area ripe for some clear thinking and design. I have been working on this a lot for the USA where Meaningful Use is driving a lot of interoperability requirements. In general, the labs performing the tests have control over defining the tests (which need to be LOINC coded) and that there is not a lot of understanding how this will impact clinicians who have to search and order tests properly, or view the results in a clinically reasonable way (in flowsheets or tables). In general, I think the rule that LOINC will be used to describe the tests (orders and results) and that SNOMED will be used to code the actual result of the tests (when not numeric, etc.) is going to hold. CIEL will continue to support concept definitions that are required and look forward to input from the community.

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Thanks Andy. May I forward this to the relevant persons?

Of course.