UK Core Clinical and Technical Assurance Sprint 6 Documentation Pack

UK Core Clinical and Technical Assurance Sprint 6 Documentation Pack

Pathology

Use of UK Core

  • DiagnosticReport
  • MessageHeader
  • Observation
  • Organization
  • Patient
  • Practitioner
  • ServiceRequest
  • Specimen

User Stories

See here for a link to the Sprint 6 Pathology slides.

Use Case - Dynamic Function Test

As a Pathologist, I want:

  • to create a report for the results of a dynamic function tests (e.g. Oral Glucose Tolerance Tests)
  • the results to be logically ordered according to the series test type
  • the test results to be grouped or sequenced in the correct order

So that:

  • it meets the needs of the originating test request in order to inform the requesting HCP and the patient of their results

n.b. This user story relates to a series tests conducted over a set number of intervals. These are often referred to as “dynamic function tests” (DFT’s) and measure the outcome of certain stimulants (or suppressants) usually invoked on the endocrine system. Results are collated then reported all at once, in order along a timeline.

Use Case Flows

Actors (for sending):

Analyser machine, Laboratory Information Management System (LIMS), Pathologist or Biomedical Scientist

Pre-conditions:

  1. Tests to measure glucose levels in blood serum aliquots are run in the lab using appropriate automated equipment e.g. tracking systems and chemical analysers
  2. Specimens are received and expected at the lab at given intervals to then load into analyser each time
  3. Each result is ‘sent’ electronically from the analyser machine through to the LIMS system – linked to the patient and request details

Basic flow:

  1. (It is assumed that) the analyser and LIMS system are programmed to receive the DFT results in order and display them for review both during the series and at the end of the last test.
  2. The results may be sent automatically via LIMS, more so if there are no abnormal results, to the GP ‘system’

Alternate course(s):

  1. Results are abnormal and the results are held for review before being sent.
  2. The Pathologist may wish to re-review the results, manually sending them when finished reviewing.

Post conditions:

  1. Indication given on LIMS system that results have been sent

Exception flows:

  1. Sending error is notified to the Lab Technician / Pathologist

Example:

Dynamic Function Test

Use Case - MC&S Microbiology Report

As a Pathologist, I want:

  • to be able to create a report for a microbiology test e.g. culture and sensitivity
  • to be able to describe the outcome or result of the microscopy which may be related to either appearance or behaviour of organisms
  • to be able to indicate the proposed treatment (e.g. specific antibiotics)

So that:

  • it meets the needs of the originating test request in order to inform the requesting HCP and the patient of their results

Use Case Flows

Actors (for sending):

Microbiology observer, LIMS system, Pathologist or Biomedical Scientist

Pre-conditions:

  1. Specimen sent from patient is processed and/or cultured, and examined by microscopy
  2. Observations are recorded by microbiologist into LIMS system, results linked to the patient and request details

Basic flow:

  1. Results and observations are recorded into LIMS system using a mixture of semi-quantitative values and descriptions
  2. Sensitivities are also recorded to aid use of effective antibiotic treatment
  3. The results are checked and sent back to the GP / patient from the LIMS system

Alternate course(s):

  1. Results are of concern and are held for review before being sent.
  2. Results are of concern and specimen may need to be sent to a specialist referral lab
  3. Microscopy may be the result of an inconclusive NAAT test

Post conditions:

  1. Indication given on LIMS system that results have been sent

Exception flows:

  1. Sending error is notified to the Lab Technician / Pathologist

Example:

MC&S Microbiology Report

Use Case - Test Requests - Single

As a Health Care Professional, I want:

  • to be able to create a request for a pathology test for the patient and send this electronically to the lab
  • to enter and send the relevant clinical details about the patient in context of the test request (e.g. medication, diagnosis) inc. all other meta-type data i.e. date, time, patient details
  • to enter details about the specimen if taken at my clinic

So that:

  • the patient can (arrange to) have their specimen sampled (and subsequently investigated at the lab), and;
  • the lab knows what test(s) to perform on the specimen, and carry them out in order to generate findings, and;
  • I can then provide any relevant interventions necessary according to any findings

Use Case Flows

Actors (for sending):

Blood analyser machine, LIMS system, Pathologist or Biomedical Scientist

Pre-conditions:

  1. Specimen sent from GP/patient
  2. Request and specimen details entered into LIMS system
  3. Specimen loaded into lab tracking system and then analyser for analysis
  4. Results relayed to LIMS system

Basic flow:

  1. Results may be automatically send to GP/patient if no abnormalities detected
  2. Results may be checked by Pathologist if abnormal before being sent or notes added

Alternate course(s):

  1. Results are abnormal and are held for review before being sent.

Post conditions:

  1. Indication given on LIMS system that results have been sent
  2. Results received by GP via MESH

Exception flows:

  1. Sending error is notified to the Lab Technician / Pathologist

Example:

Test Requests - Single

Use Case - Test Requests - Multiple

As a Health Care Professional, I want:

  • to be able to create a set of multiple tests based on the symptoms or condition presented by the patient and send this electronically to the lab (e.g. see GIRFT ‘care sets’)
  • to enter relevant clinical details about the patient in context of the requests (e.g. symptoms) inc. all other meta-type data i.e. date, time, patient details
  • to enter details about the specimen if taken at my clinic

So that:

  • the patient can (arrange to) have their specimen sampled (and subsequently investigated at the lab), and;
  • the lab knows what tests to perform on the specimen, and carry them out in order to generate findings, and;
  • I can then provide any relevant interventions necessary according to any findings

Use Case Flows

User Story 2

As Pathologist I want:

  • To be able to create a report for the results borne from a single request panel (or profile) e.g. Full Blood Count, Lipid Profile
  • The results to be logically ordered according to the given profile and/or best practice guidelines

So that:

  • It meets the needs of the originating request in order to inform the requesting HCP and patient of a set of results

Use Case Flows

Actors (for sending):

Blood analyser machine, Chemical analyser machine, LIMS system, Pathologist or Biomedical Scientist

Pre-conditions:

  1. Specimen(s) sent from GP/patient to lab
  2. Request and specimen details entered into LIMS system
  3. Specimen loaded into lab tracking system and then different analysers for analysis
  4. Results relayed to LIMS system

Basic flow:

  1. Results sent to LIMS as analysers finish testing, may need to wait for all tests to complete
  2. Results relating to all tests on one report - may be automatically send to GP/patient if no abnormalities detected

Alternate course(s):

  1. One sample may be enough for multiple requests, or a multiple specimens may form a mixture of single or multiple requests per specimen
  2. If any of the results are abnormal they may be held for review before being sent.

Post conditions:

  1. Indication given on LIMS system that results have been sent
  2. Results received by GP via MESH

Exception flows:

  1. Sending error is notified to the Lab Technician / Pathologist

Example:

Test Requests - Multiple

Use Case - Send-away Test (lab to lab)

As a Pathologist, I want:

  • to be able to create and send a request for a ‘send-away test’ (send specimen and request(s) to another lab)

So that:

  • I can further investigate the patient’s condition with tests provided by a separate specialist lab

n.b. See also 'Create and Send a Request' where specifications should be similar albeit tailored to send details from the laboratory system instead.

Use Case Flows

Actors (for sending):

Pathologist or Biomedical Scientist, LIMS system, Referral lab system, Referral lab pathologist

Pre-conditions:

  1. Specimen and request received by local lab

Basic flow:

  1. Local lab unable to perform test (i.e. does not have capability)
  2. Sends specimen and request (message) to specialist referral lab
  3. Referral lab receives request and specimen and conducts testing

Alternate course(s):

  1. Local lab may have performed some tests on the specimen(s) but is unable to perform this single more specialist tests

Post conditions:

  1. Tests are performed by referral lab and results sent back to local lab

Exception flows:

  1. Sending error is notified to the Lab Technician / Pathologist

Example:

Send-away Test

Use Case - Reflex Test

As a Pathologist, I want:

  • to be able to add one or more test results to the report in progress, borne from reflex or reflective tests in response to the initial results
  • the results of the reflex test to be indicated as such (i.e. an additional test) and/or addition of comments

So that:

  • I can add clinically relevant test results to the initial result for the requesting organisation, to help towards the patients treatment plan and;
  • it reduces time processing future requests, preventing delays to the patient’s treatment

Use Case Flows

Actors (for sending):

Chemical analyser machine, (Algorithm enabled further tests indicator, LIMS system, Pathologist or Biomedical Scientist

Pre-conditions:

  1. Specimen(s) sent from GP/patient to lab
  2. Request and specimen details entered into LIMS system
  3. Specimen loaded into lab tracking system and then different analysers for analysis
  4. Results relayed to LIMS system

Basic flow:

  1. Results from initial test (TSH) are returned abnormal
  2. Algorithm picks this up and ‘orders’ further testing on sample for Free T4 and T3 levels
  3. All results sent to LIMS
  4. Pathologist checks results and sends to GP/patient

Alternate course(s):

  1. The pathologist may manually check the TSH levels themselves, and manually initiate the subsequent required T3 and T4 tests (may also be known as a reflective testing)

Post conditions:

  1. Indication given on LIMS system that results have been sent
  2. Results received by GP via MESH

Exception flows:

  1. Sending error is notified to the Lab Technician / Pathologist

Example:

Reflex Test

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