P016 Overcoming electronic medical record interoperability challenges with a combined discrete data and encapsulated binary test results interface

Abstract

Aim Our aim is to deeply integrate University of Nebraska Medical Center’s institutional electronic medical record (EMR), EPIC, and HLA Laboratory Management System, mTilda, in order to achieve: streamlined clinician order entry and resulting; a higher level of fidelity of discrete HLA data within the EMR in preparation for data intensive test types including Next-gen Sequencing; the automation of manual and error-prone processes by means of a data interface capable of receiving orders and sending test results programmatically. Methods Process maps of paper-based HLA laboratory functions and workflows were prepared and optimized by deploying a laboratory management information systems and enterprise interface platform (MIRTH) that is Health Level 7 (HL7) compliant. The HLA lab identified forty-nine (49) unique HLA test types to send via HL7 data interchange. Results The HL7 data format was extended to allow clinician-readable test results to be sent to the EMR as binary 64-bit encapsulated PDFs through the HL7 Order Message protocol. The HL7 Reference Information Model (RIM) was extended to include discrete HLA laboratory meta-data from test results. Conclusions Extending the HL7 data model allowed us to encode higher volume and fidelity of discrete HLA data into an HL7 results message interface for integration into the EMR database. As EMR vendors expand their data model to include HLA-specific database fields, it is increasingly important to send a combination of discrete HLA test results data and traditional well-formatted PDF reports to ensure that a patient’s longitudinal medical records include immunogenetic-relevant discrete data.