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Australian Diagnostics and Referral Messaging - Localisation of HL7 Version 2.4, Release 2 is the Australian localisation of the international HL7 V2 Standard covering the Laboratory/Diagnostics/Clinical result reporting, laboratory/radiology ordering specification and patient referral. The term "Diagnostics" covers non laboratory reporting including reporting of diagnostic imaging and non referral related clinical reporting (for example: echocardiography, respiratory function, endoscopy, stress testing, sleep studies). The term pathology in Australia covers all aspects of laboratory medicine including clinical and anatomical pathology domains. The relationship between Pathology Practices and , while the term “radiology” is understood to include all diagnostic imaging modalities, whether X-ray based or other (eg ultrasound).
The relationship between pathology and radiology practices and their customers in Australia is considered by Government and others as similar to that between other consultant specialists and their customers. For that reason, what HL7 would call an order is generally called a request here and the response by the pathology provider (a formal term meaning the responsible specialist(s)) is called a report. For some disciplines such as microbiology, anatomical pathology, genetics and genomics the request is more by way of asking a clinical question expecting the pathology provider to understand the best way of answering it - eg Is this cancer, if so what type, and what is the prognosis? It is expected this form of requesting will become more common as laboratory medicine evolves. In radiology, it is generally necessary for the request to include clinical information relevant to the purpose of the request, to enable the optimal choice, and interpretation, of the examination. It is also frequently necessary that the request contain information relevant to safety issues that may arise from performance of the test, such as contrast allergies, renal disease, etc.
The use case here focuses on widely-available, well-standardized methods that will support the secure access to electronic laboratory orders and radiological requests and results and interpretations for clinical care by authorized parties and is driven by the need for timely electronic access to requested, referred and historical lab results. Requesting clinicians (the Placer) receive test results in the form of a HL7 V2 message, as a response to a request (electronic or paper) or as an unsolicited message by having the report directly sent by the pathology practice (the Filler) to the clinician for importation into their local systems. Images generated in the course of a radiological procedure are not sent in an HL7 message. Depending on the referrer’s requirements, and local technical capabilities, images may be made available on traditional analogue film (rapidly becoming obsolete), portable digital media, or, increasingly, in digital form via an online electronic portal.
Referral messaging covers clinical referral between clinicians and hospitals, as well as hospital discharge and includes a patient history summary suitable for constructing a Virtual Medical Record for use in decision support and can include any pathology/radiology/diagnostics reports relevant to the referral. It also includes a Medication summary.
This document tries to provide coverage for all laboratory messaging laboratory and radiological messaging scenarios in the Australian context including public and private entities, hospital and community and public health entities. The referral messaging covers referral between medical practitioners, allied health and hospitals. It covers referral between practitioners, referral to hospitals and hospital discharge.
The Royal College of Pathologists of Australasia (RCPA) has developed a number of policies around safety in requesting and reporting of pathology including the use of terminology and the transmission of data. These policies have been incorporated into this document. Similarly, the Royal Australian and New Zealand College of Radiologists has defined minimum requirements for the content of referrals and reports. Standardised terminology for radiological procedures is being developed, and will be progressively implemented throughout the sector.
This document and the specifications in it supersede those in AS 4700.2-2012 - Implementation of Health Level Seven (HL7) Version 2.4 - Pathology and diagnostic imaging (diagnostics) and HB 262 (Rev)-2012 - Guidelines for messaging between diagnostic providers and health service providers, and AS 4700.6-2006 Implementation of Health Level Seven (HL7) Version 2.4 Part 6: Referral, discharge and health record messaging.
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This guide contains the necessary specifications for pathology and radiology requests and reports in Australian healthcare using the HL7 V2.4 protocol. Where appropriate aspects of later versions of HL7 V2 have have been incorporated into this localization. Where this is done it is flagged as a variation from v2.4.
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- 67. @Vanessa Cameron to identify RCPA Informatics Committee Fellow representative for HL7.au O&O meetings
- 68. @Vanessa Cameron to identify RCPA secretarial support ASAP for ongoing HL7.au O&O meetings
- 69. @Jared Davison to add Diagnostic Imaging content by Nick Ferris on behalf of RANZCR to 1. Introduction
- 70. @Kieran McGuire needs to be in attendance to review proposal for 3.31.6 Degree (IS) – Consider adding AU codesystem for qualifications beginning with 2 codes for V2 compatibility - Table 0360 Degree compatibility
- 71. @Jared Davison & @Andrew McIntyre - 4.4.1.13 OBR-13 Relevant clinical information (ST) 00247 - add text for instructions for OBX code use.
- 72. @Jared Davison to make a PDF of ‘Pre-release’ document HL7AUSD-DFC-OO-ADRM-2020.1 Australian Diagnostics and Referral Messaging - Localisation of HL7 Version 2.4.
- 73. @Jared Davison to provide PDF to @Brett Esler and @Jason Steen asking them to distribute to all HL7.au members on behalf of O&O wg, and other interested parties. All feedback ‘informal phase’ preferred via Confluence or via email to @Andrew McIntyre or @Michael Legg.
- 74. @Vanessa Cameron to ask RCPA to distribute ‘Pre-release’ draft to interested parties, especially NPAAC Committee.
- 75. @Jared Davison to schedule GoTo Meeting for next HL7.au O&O meeting Tuesday 02 February 2021 10:00 AEDT.