England Pathology and Laboratory Medicine (PaLM) Technical Framework
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IHE PaLM Technical Framework in England

The IHE Pathology and Laboratory Medicine (PaLM) Technical Framework defines profiles (Volume 1), the transactions they use (Volume 2) and content (Volume 3) for laboratory and pathology workflows. IHE profiles are international; a national extension or localisation says how they are used in one country. This guide is a localisation for England.

The IHE PaLM Profiles

Profile What it covers In England This guide
Laboratory Testing Workflow (LTW) Ordering, scheduling and resulting of in vitro diagnostic tests between the clinical world and the laboratory Order communications / EPR / GP system to LIMS, and LIMS results back. The core of this guide LTW
Inter-Laboratory Workflow (ILW) A laboratory sub-contracting tests to another laboratory Pathology networks (hub and spoke) and referrals to specialist and reference laboratories ILW
Laboratory Analytical Workflow (LAW) LIMS / middleware to analyser work orders and results Inside the laboratory - usually supplier middleware Outline only
Laboratory Device Automation (LDA) Pre- and post-analytical automation Inside the laboratory Outline only
Laboratory Barcode Labeling (LBL) Specimen container labels Order comms label printing (placer specimen numbers) Outline only - see Specimen identifiers
Laboratory Point Of Care Testing (LPOCT) Point of care testing devices POCT middleware to LIMS / EPR Outline only
Laboratory Clinical Specimen Data (LCSD) Clinical data needed by the laboratory to process specimens Ask at order entry questions and clinical details LAB-1 (OBX and NTE following the OBR)
Sharing Laboratory Reports (XD-LAB) Laboratory reports as shareable documents Shared care records, the NHS England Pathology Laboratory Reporting API (FHIR Document) Results Distribution, Pathology Laboratory Reporting API
Anatomic Pathology Workflow (APW) and Structured Reports (APSR) Cellular pathology ordering and structured reports Cellular pathology LIMS, RCPath datasets, COSD Out of scope - see Cancer Pathology Report

Transactions Used in This Guide

Transaction From To HL7 v2.5.1 FHIR (this guide)
Placer Order Management [LAB-1] Order Placer Order Filler OML^O21 / ORL^O22 Laboratory Order (O21) message
Filler Order Management [LAB-2] Order Filler Order Placer OML^O21 (SN, OC, SC) / ORL^O22 Laboratory Order (O21) message
Order Results Management [LAB-3] Order Filler Order Result Tracker ORU^R01 / ACK^R01 Laboratory Result (R01) message, or a Laboratory Report Document
Sub-order Management [LAB-35] Requester Subcontractor OML^O21 / ORL^O22 Laboratory Order (O21) message
Sub-order Results Delivery [LAB-36] Subcontractor Requester ORU^R01 / ACK^R01 Laboratory Result (R01) message

What England Adds

The IHE profiles say which messages to send. A localisation also has to say how to fill them in. For England this guide adds:

  • Content - DAPB4101 everywhere. The NHS England Pathology and Laboratory Medicine Reporting information standard (DAPB4101) is written for reporting to general practice. This guide recommends that its content - SNOMED CT PaLM codes, units, report structure - is applied across England: LIMS to trust EPR, laboratory to laboratory, to shared care records and to GP systems, in HL7 v2 as well as FHIR. A result then means the same thing on every route, and moving it between routes (for example ORU^R01 to the NHS England API) changes the container, not the content
  • Identifiers - NHS Number (PID-3 with assigning authority NHS and type NH), ODS codes for organisations (MSH-4, MSH-6, XON-10), GMC / NMC / HCPC / GP (GMP) codes for clinicians (XCN-1 with XCN-9), and placer / filler order and specimen numbers - see HL7 v2.5.1 Segments and FHIR Resources
  • Terminology - SNOMED CT UK Edition for tests and results (the PaLM codes used by DAPB4101), with LOINC as an optional second code, UCUM for units - see Terminology
  • National services - the NHS England Pathology Laboratory Reporting API (replacing Pathology Messaging EDIFACT to GP systems), Patient Data Manager and the Multicast Notification Service
  • FHIR - the FHIR equivalent of each HL7 v2 message, built on HL7 Europe Laboratory Report (as the NHS England Pathology FHIR IG is), and the mapping between them