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Lab Orders and Results exchange between OpenMRS and OpenELIS

The Lab Order workflow between OpenELIS and OpenMRS will use the OpenMRS FHIR Workflow Module and suggested Communication Patterns to implement the ordering of lab tests from OpenMRS to OpenELIS and the returning the results to OpenMRS.

The current communication workflow uses HL7 V2.5.1 messages as documented here: (https://github.com/openelisglobal/openelisglobal-core/wiki/Result-Reporting). This functionality is implemented in openmrs-module-labintegration, an OpenMRS module made for an implementation of OpenMRS deployed in Haiti called iSantePlus.

Communication Overview

screen1

Intergration Between iSantéPlus and OPenELIS

iSantéPlus

  1. Install iSantePlus using one of the following approaches:

  2. Docker: https://github.com/IsantePlus/isanteplus-docker

  3. Apache Tomcat WAR: SOP iSantePlus Installation.docx

  4. Install the OpenMRS FHIR module using the following omod file: openmrs-module-fhir2.omod

  5. Install the iSantePlus Lab on FHIR module using the following omod file: labonfhir-1.0.0-SNAPSHOT.omod

  6. Restart iSantePlus

Start up the OpenELIS Update Task in System AdministrationAdvanced AdministrationSchedulerManage Scheduler

screen1

OpenELIS Global 2.x

  1. Install OpenELIS Global 2.x using the instructions HERE
  2. Navigate to the "results reporting" configuration: https://IPforyourserver:8443/OpenELIS-Global/ResultReportingConfiguration
  3. Move the radio button for Result Reporting to "Enable" and enter in the URL for the OpenMRS connection like in the example below.
  4. Please note, the Test URL button may not respond to the FHIR module, so please disregard any errors if you click it.
  5. Click Save at the bottom of the page.

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FHIR Based Intergration Between Openmrs 3.x and OPenELIS 2.6

Openmrs 3.x

  1. Setup OpenRMS 3.x on top an instance of the Refference Application see more

  2. Load the Following Modules

  3. Configure the required settings .

    • labonfhir.openElisUrl ,The URL for the FHIR server where OpenELIS polls the Orders From.
    • labonfhir.openElisUserUuid ,UUID for the service user that represents OpenELIS

    see more on Configuring the above Modules.

    Note: The Lab test Concept should be of class Test ,and should be mapped to a Loinc code that matches a the Test Loinc Code in OpenELIS

  4. Go to the Reff App (2.x) Patient Dashbord ,Go to Prescribed Medication Widget. screen1

    See more on Creating Orders using the Order Entry Owa.

    screen1

  5. If the Lab on FHIR module is rightly configured ,it will generate the lab FHIR Bundle and push to the remote Fhir Server for OpenELIS to poll the orders

  6. Start the OpenELIS Pull Task ,to start polling for Lab Results via the Sheduler Interface
    System AdministrationAdvanced AdministrationSchedulerManage Scheduler

    ![screen1](img/omrsoe1.png)
    
  7. To view the lab Results , Ensure you have the patient-test-results-app. Go to the Patient DashBoard in 3.x ui and click Test Results. screen1

OpenELIS Global 2.6.x

The FHIR based Lab Workflow is supported in OpenELIS 2.6 .

  1. Start an instance of OpenELIS with the following configuration properties set in the properties file.

  2. org.openelisglobal.fhirstore.uri=<localFhirServerUrl> . This is the Fhir Server that runs paralel with OPenELIS

  3. org.openelisglobal.remote.source.uri=<remoreFhirServerUr>. This is the Fhir server that the Lab on FHIR module points to ie via the labonfhir.openElisUrl

  4. org.openelisglobal.remote.source.updateStatus=true
  5. org.openelisglobal.remote.source.identifier=Practitioner/<userUuuid> .This is the UUID of the user who created the Order ie labonfhir.openElisUserUuid
  6. org.openelisglobal.task.useBasedOn=true

  7. org.openelisglobal.fhir.subscriber=h<remoreFhirServerUrl> .

  8. org.openelisglobal.fhir.subscriber.resources=Task,Patient,ServiceRequest,DiagnosticReport,Observation,Specimen,Practitioner,Encounter

  9. Ensure OpenELIS has the test that maps to the same LOINC code as the test Concept in OpenMRS. This can be added via the
    Admin pageTest ManagementAdd Tests screen1

  10. Configure OpenELIS to accept electronic order. AdminOrder Entry Configurationexternal orders screen1

  11. Search for the Electronic Order ie
    OrderElectronic Orders and then Complete the Order Note that the user should have the right Lab Unit Priviledges to complete the Order screen1

  12. After Results are captured and Validated , OpenELIS sends back the results to OpenMRS as a Diagnostic Report with an Observation

Required FHIR Resources

Task

more info

The Task resource is created along with the corresponding ServiceRequest resource when a clinician creates a TestOrder and decides to send it to OpenELIS.

This resource is used to track the status of the lab order request from initiation to completion, and as a container for all other resources related to the given order.

Example Task:

{
    "resourceType": "Task",
    "id": "88ffa7fb-0419-4097-8b45-24f0d843c5ea",
    "identifier": [
        {
            "system": "http://isanteplus.org/ext/task/identifier",
            "value": "88ffa7fb-0419-4097-8b45-24f0d843c5ea"
        }
    ],
    "basedOn": [
        {
            "reference": "ServiceRequest/ebf83ba0-9d3c-497f-9aa0-d839ec506202",
            "type": "ServiceRequest"
        },
        {
            "reference": "ServiceRequest/73e96ecb-a78d-41c8-a55f-d9b90f759e5f",
            "type": "ServiceRequest"
        }
    ],
    "status": "requested",
    "intent": "order",
    "for": {
        "reference": "Patient/e14e9bda-d273-4c74-8509-5732a4ebaf19",
        "type": "Patient"
    },
    "encounter": {
        "reference": "Encounter/7f5aabd9-6375-47c8-a8d6-30f219b6e2f1",
        "type": "Encounter"
    },
    "authoredOn": "2020-04-28T17:33:19+00:00",
    "owner": {
        "reference": "Practitioner/f9badd80-ab76-11e2-9e96-0800200c9a66",
        "type": "Practitioner"
    }
}

ServiceRequest

more info

The ServiceRequest resource represents the TestOrder placed in OpenMRS. It is referenced from the Task with the Task.basedOn element, and sent to OpenELIS with the Task to initiate the processing of the order.

Example Service Request:

{
    "resourceType": "ServiceRequest",
    "id": "73e96ecb-a78d-41c8-a55f-d9b90f759e5f",
    "status": "active",
    "intent": "order",
    "code": {
        "coding": [
            {
                "code": "790AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
            },
            {
                "system": "http://loinc.org",
                "code": "14682-9"
            },
            {
                "system": "urn:oid:2.16.840.1.113883.3.7201",
                "code": "790"
            }
        ]
    },
    "subject": {
        "reference": "Patient/e14e9bda-d273-4c74-8509-5732a4ebaf19",
        "type": "Patient"
    },
    "encounter": {
        "reference": "Encounter/7f5aabd9-6375-47c8-a8d6-30f219b6e2f1",
        "type": "Encounter"
    }
}

DiagnosticReport

more info

The DiagnosticReport resource is the container for the results of an Order, and holds these results in the DiagnosticReport.result element as references to Observation resources.

Example Diagnostic Report

{
  "resourceType": "DiagnosticReport",
  "id": "93",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2020-04-28T17:33:36.163+00:00",
    "source": "#55t4lpDZF4q3TCZ0"
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><div class=\"hapiHeaderText\"> Untitled Diagnostic Report </div><table class=\"hapiPropertyTable\"><tbody><tr><td>Status</td><td>FINAL</td></tr></tbody></table></div>"
  },
  "identifier": [
    {
      "system": "https://isanteplusdemo.com/openmrs/ws/fhir2/",
      "value": "ebf83ba0-9d3c-497f-9aa0-d839ec506202"
    }
  ],
  "status": "final",
  "code": {
    "coding": [
      {
        "code": "1008AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
      },
      {
        "system": "http://loinc.org",
        "code": "22748-8"
      },
      {
        "system": "urn:oid:2.16.840.1.113883.3.7201",
        "code": "1008"
      }
    ]
  },
  "subject": {
    "reference": "Patient/2"
  },
  "result": [
    {
      "reference": "Observation/92",
      "type": "Observation"
    }
  ]
}

Observation

more info

The Observation resource contains the results of the Lab Order request.

Example Observation:

{
  "resourceType": "Observation",
  "id": "92",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2020-04-28T17:33:36.124+00:00",
    "source": "#xAVz0uUE6c3l42Za"
  },
  "identifier": [
    {
      "system": "https://isanteplusdemo.com/openmrs/ws/fhir2/",
      "value": "ebf83ba0-9d3c-497f-9aa0-d839ec506202"
    }
  ],
  "status": "final",
  "code": {
    "coding": [
      {
        "code": "1008AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
      },
      {
        "system": "http://loinc.org",
        "code": "22748-8"
      },
      {
        "system": "urn:oid:2.16.840.1.113883.3.7201",
        "code": "1008"
      }
    ]
  },
  "subject": {
    "reference": "Patient/2"
  },
  "valueQuantity": {
    "value": 55,
    "unit": "UI/L"
  }
}

Patient

more info

The Patient resource contains vital information for OpenELIS to fullfill the lab order request, and is referenced by the Task.

Example Patient:

{
    "resourceType": "Patient",
    "id": "e14e9bda-d273-4c74-8509-5732a4ebaf19",
    "identifier": [
        {
            "id": "5981a256-d60c-44b1-beae-9bdd2cf572f8",
            "use": "official",
            "system": "iSantePlus ID",
            "value": "10012R"
        },
        {
            "id": "75a67d54-6fff-44d1-9c3e-2116c967b475",
            "use": "usual",
            "system": "Code National",
            "value": "100000"
        },
        {
            "id": "29447d21-3cd6-42a9-9ab2-79ebfa710a01",
            "use": "usual",
            "system": "ECID",
            "value": "04d759e0-5d02-11e8-b899-0242ac12000b"
        }
    ],
    "active": true,
    "name": [
        {
            "id": "511275de-e301-44a3-95d2-28d0d3b35387",
            "family": "Mankowski",
            "given": [
                "Piotr"
            ]
        }
    ],
    "gender": "male",
    "birthDate": "1987-01-01",
    "deceasedBoolean": false,
    "address": [
        {
            "id": "d4f7c809-3d01-4032-b64d-4c22e8eccbbc",
            "use": "home",
            "country": "Haiti"
        }
    ]
}

Relevant FHIR Docs

Relevant OpenMRS Talk Posts

The handling and mapping of lab order status for the lab workflow