eDOS Initiative

ACLA eDOS INITIATIVE

The American Clinical Laboratory Association (ACLA) represents national, regional, and local laboratories that collectively have an extensive history of providing the nation’s hospitals and physicians with leading-edge health information technology (IT) to streamline the laboratory test requisition process and speed the delivery of test results.

The development of a framework for the Laboratory Test Compendium to provide the ability to electronically exchange the Directory of Services (eDOS) as outlined in this document is a critical step in the increased interoperability requirement between commercial EMR systems and laboratory providers. This development effort fills a gap in the current paradigm of point to point interfacing in the laboratory industry and will reduce costs for both clients and laboratories while further decreasing error rates, as it will simplify the exchange of data related to test Directories of Services and associated orders, while increasing their functionality and value within compatible EMR systems.

Thus, a cross-functional ACLA workgroup has been working on the development of an industry standard framework for eDOS data exchange and test ordering that will enhance interoperability as defined within the scope of the American Recovery and Reinvestment Act (ARRA) for Health IT. Essentially, the industry standard will enable one or more clinical laboratories to automatically and remotely load, update, and maintain their eDOS electronically within the physician's EMR system of choice. The framework is based on the HL7 messaging protocol to maximize industry acceptance and adherence to existing standards. It is not designed to be a “universal” Test Compendium in the sense of a single standardized common set of order codes but, rather, is intended to provide a simple and low-cost vehicle so all clinical laboratories can share their eDOS with their clients and enable EMR systems to support all order codes used by the laboratories that the physician selects and uses.

While other entities are working on standards and specifications intended for similar uses, it is our belief that the clinical laboratory industry is naturally suited to define the standards for sharing and distributing the eDOS, which is a laboratory resource that is unique to each laboratory. ACLA strongly believes that the key to successful data exchange in this area is to design the framework by which test information can be seamlessly shared between laboratory providers and EMR systems. This is why development of a standard Laboratory Test Compendium Framework addresses and defines HOW information that differs by laboratory, such as the following, can be easily exchanged between all provider laboratories used by a client and the client’s EMR system:

• The codes used to order laboratory tests and the description of the laboratory tests
• The nature of the test (profile, single observation, etc)
• The potential reflex observations
• The specimen requirements
• The processing priorities (ability to order as stat, routine, or other priorities)
• A list of analytes included in the Lab Order Code
• The additional clinical and useful information required at the time of ordering

The adoption of the standard framework will enable easy initial laboratory test compendium downloads for every client.  Laboratories, in coordination with their customers, can determine whether a complete eDOS or a subset (based on the customer’s ordering history or other considerations) is appropriate for a specific customer.  Alternatively, the EMR software vendor or the client will be able to request a complete updated copy of the Laboratory Test Compendium or specific updates from each laboratory utilized by the client.

The working group is actively seeking feedback from the following: 1.) ACLA membership at large; 2.) the Office of the National Coordinator; 3.) HITSP; 4.) EMR vendors; and 5.) the general public.  Once the specification is complete and all suggestions are considered, the working group will reach out to the HL7 standards committee, with the intent to transfer the Laboratory Test Compendium Framework to that entity. It is the belief of the ACLA working group that HITSP, the EHRA, and subsequently the HL7 will seriously consider adopting this proposal to avoid the drawbacks of other proposals considered to date.

REQUEST FOR PUBLIC COMMENTS:  the current public comment period will remain open for 60 days through March 5, 2010 (at 5 PM EDT).  Comments will only be accepted using the form provided below.

ACLA LABORATORY TEST COMPENDIUM FRAMEWORK (670 kb)

RESPONSES TO THE PUBLIC COMMENTS ON ACLA's TEST COMPENDIUM FRAMEWORK (83 kb)