Whole Slide Imaging Integration with Lab Information Systems, a Study of the Requirements, Processes and Procedures Enabling a Reporting-Based Workflow

Figures & data

Figure 1 High level diagram of Cerner, Cloverleaf and IMS Communications.

Table 1 Analysis of the HL7 Cloverleaf Message

HL7 Field	Name	Example	Comment
PID 3.1	Patient ID	1000000000	Patient identifier, required for merger of patient and change of information update
PID 5	Patient Name	Family^Given^ Middle	Once changed will trigger a message trigger change name in the IMS
PID 7	Date of Birth	20120703	Enables establishing age, and will trigger a message once changed
PID 8	Sex	M
ORC 1	Status	CM	NW-Ordered, CM-Completed, Cancel-Cancelled
ORC 12	Assigned Pathologist	24429^Alchami^Fouad^^^^^^ExternalId^	Mapped in IMS to AD-ID via Look Up table “Provider who requested this order action.”
OBR 4.1	Staining	H\T\E Embed^Embed	“H&E”, Staincode^Stainname, displayed by IMS
OBR 20.1	Accession Number	00001SP20180000676^HNA_ACCN~	Accession number
OBR 27.4	Date/Time	1^^0^20180903145700	Order Creation
OBR 15	Specimen Type	APSpecimen&AP Specimen^^LIVER BIOPSY	Specimen Type as per request form
SAC 2	Case ID	00001SP20180000676^ SP-18-0000676^	Barcode^Display^Sorting
SAC 3	Block ID	^1^001	Specimen grouping
SAC 4	Part ID	^A^001	Pot and specimen

Note: The symbols ^, ~, _ are parts of the separation between different elements of the HLA7 message.

Figure 2 Sample HL7 message. The symbols ^, ~, _ are parts of the separation between different elements of the HLA7 message, and do not infer any additional implications. The names that appear in the message are mock names/author names used to clarify elements of the message. There is no patient identifiable information.

Figure 3 Full end-to-end integration workflow.

Figure 4 Communication flow of messages with trigger events.

Figure 5 Folders in IMS.

Table 2 Validation of the integration scripts

Requirement Description	Test Cases	Expected Result
Register Patient A in Cerner, and check whether the patient details are registered in the IMS	1. Create a patient	The patient data is successfully registered in IMS.
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS
	3. Validate patient registration in IMS
Update Patient’s Name / Sex / DOB and check whether the patient details are updated in the IMS	1. Open the modify person module, and update the patient’s information	The patient data is successfully updated in IMS.
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS
	3. Validate whether the patient is successfully updated in the IMS
Merge Patient A to Patient B	1. Create patient B	The patient data is successfully merged in IMS.
	2. Combine Patient A to Patient B
	3. Validate whether Cloverleaf has received merge patient information, and send the HL7 messages to IMS
	4. Validate whether the patient is successfully merged in the IMS
Create single Pathology tissue request order in DOE, accession as SP using Maintain case, assign no Pathologist in charge, ensuring IMS is updated.	1. Use existing patient to place urgent order	All patient demographics are received in IMS. Urgency status is captured.
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS
Create multiple Pathology tissue request order in DOE, accession as BM (pathologist 1 in Charge) using Maintain case, ensuring IMS is updated.	1. Use existing patient to place routine order	All patient demographics are received in IMS. Routine status is captured and specimen source is displayed. Pathologist in charge details are updated.
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS
	3. Update Pathologist in Charge field from one pathologist to another
	4. Confirm all specimen source information displays
Create Single Pathology tissue request order in DOE (Urgent as priority), accession as AU (pathologist 2 in charge) using Maintain case, ensuring IMS is updated.	1. Use existing patient to place routine order	All patient demographics are received in IMS. Routine status is captured and specimen source is displayed. Pathologist in charge details are updated.
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS
	3. Update urgency from Urgent to Routine
	4. Confirm all specimen source information displays
Saving snapshots to pre-determined location:	1. Save snapshot of slide A.1–1	Snapshot file appears in expected location
In PTOE, place orders for all expected PTOE tasks generating a slide ID.	1. Use existing case created in 208.E1354.D to place PTOE tasks.	All requested PTOE tasks sent to IMS when slides are scanned on UFS/UVS.
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS. Case folder in IMS to display total number of slides scanned.
Cancellation of tasks messages are transferred to IMS	1. Use existing case created in 208.E1354.D to cancel PTOE task. Only cancel 1 task.	Cancelled PTOE task sent.
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS
Deleted slides in IMS re-appear after being re-scanned on UFS/UVS	1. Delete slide A.1–1	Slide re-appear in IMS.
Verify tasks in PTOE	1. Open Outstanding tasks in PathNet	Completed task information message is sent to IMS
	2. Use existing case, to verify PTOE tasks for one existing task with an associated slide ID
	2. Validate whether Cloverleaf has received, and send the HL7 messages to IMS

Figure 6 Integration issues requiring integration team input.