Combining patient data from multiple sources to form a whole record is a major focus of digital health networks. At any one time, many parts of a network may input patient data: doctor, specialist, hospital, trauma center, emergency and rehabilitative units, information systems processor, or vendor.

To integrate a patient’s clinical laboratory data with a total health profile from various sites, a standardized set of conventions between clinical laboratorians and multiple sources has been proposed in Standard Guide for Coordination of Clinical Laboratory Services within the Electronic Health Record Environment and Networked Architectures. Currently being finalized within ASTM, it was drafted by a task group of clinical laboratorians, and healthcare software suppliers, health information administrators in ASTM Subcommittee E31.13 on Clinical Laboratory Information Management, part of Committee E31 on Healthcare Informatics.

“This new document will contribute to E31.13’s participation in the point-of-care testing (POCT) connectivity effort,” says Arden Forrey, Ph.D., research associate, School of Dentistry, University of Washington Seattle, and document editor for the task group. Forrey describes the POCT effort as an “independent industry consortium” that uses standard profiles to manage POCT data by “providing contexts for the technical connectivity issues” and goes on to say the new standard “addresses all communication architectures.”

The draft states: “The standard applies to the process of defining and documenting the capabilities, the logical data sources, and pathways of data exchange within a given network architecture of a Health Information Network (HIN) serving a set of constituents.” In easy-to-follow language, it “describes how implementation methods and techniques can be used to logically coordinate clinical laboratory services and electronic health record (EHR) systems involving participating organizations and sites connected by a networked communications system.” Included are:

--Contents of the nodes and arcs of the resulting logical network involving both laboratory and EHR-capable sites;
--Considerations of various purposes and organizational arrangements for coordinating laboratory services within the network boundaries;
--Considerations for connections among external networks; and
--Other standards development organizations’ clinical laboratory information management systems (CLIMS), EHR systems, and messaging conventions.

When completed, the guide will compliment the following ASTM standards:
--E 792, Guide for Selection of Clinical Laboratory Information Management Systems;
--E 1639, Guide for Functional Requirements of Clinical Laboratory Information Management Systems;
--E 1239, Guide for Description of Reservation/Registration-Admission, Discharge and Transfer (RADT) Systems for Automated Patient Care Information Management Systems;
--E 1715, Practice for an Object Oriented Model for Registration, Admitting Discharge and Transfer Functions in Computer-Based Patient Record Systems;
--E 1384, Guide for Content and Structure of the Computer-Based Patient Record; and
--E 1663, Specification for Coded Values Used in the Computer-Based Patient Record.

These standards are available from ASTM Customer Service (610/832-9585), or through the Web site. They were developed collaboratively by Subcommittees E31.13, and E31.14 on Clinical Laboratory Instrument Interfaces, now merged as E31.13.

Forrey concludes, “The draft sets the stage for an ASTM tag value (XML) version of the combined E 1238, Specification for Transferring Clinical Observations between Independent Computer Systems, and E 1394, Specification for Transferring Information Between Clinical Instruments and Computer Systems.”

For further technical information, contact Arden Forrey, 4916 Purdue Ave., NE, Seattle, WA 98105 (206/616-1875). For meeting or membership information, contact manager Teresa Cendrowska, ASTM (610/832-9718). //

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