England Pathology and Laboratory Medicine (PaLM) Technical Framework
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Actors and Systems

IHE describes workflows in terms of actors (roles) rather than products. One NHS system can play several actors, and one actor can be played by different systems in different settings.

IHE PaLM Actors

Actor Responsibility Typical NHS systems
Order Placer Creates orders, assigns the Placer Order Number, sends them to the laboratory and tracks their status Trust EPR or order communications (order comms), GP clinical system or GP order comms (for example ICE)
Order Filler Receives orders, assigns the Filler Order Number and accession number, manages them in the laboratory and produces the results Laboratory Information Management System (LIMS)
Order Result Tracker Receives results and stores them in the patient record Trust EPR, GP clinical system, shared care record
Automation Manager Manages work orders on laboratory automation and analysers (IHE LTW / LAW) LIMS middleware
Requester (ILW) A laboratory that sends a sub-order to another laboratory Referring laboratory LIMS (for example a spoke laboratory)
Subcontractor (ILW) A laboratory that performs a sub-order and returns its results Hub, specialist or reference laboratory LIMS
Content Creator / Content Consumer (XD-LAB) Creates / consumes a shareable laboratory report document LIMS or middleware / EPR, GP system, shared care record

England-specific Systems

System Role in this guide
GP order communications (order comms) The Order Placer for GP requests, and the system that returns results to the practice. In practice the NHS England Pathology Laboratory Reporting API's laboratory middleware system is likely to be this system: it receives ORU^R01 from the LIMS and sends the FHIR Document to the API
Trust Integration Engine (TIE) The middleware inside a trust or pathology network. Routes LIMS messages to the EPR, to order comms (HL7 v2 ORU^R01) and to shared care records, and is often where HL7 v2 to FHIR conversion happens - see Mapping. Not the same thing as the NHS England "laboratory middleware system"
Results distribution middleware Older pattern: receives results from one or more LIMS and sends them to GP systems as Pathology Messaging EDIFACT (MEDRPT)
NPEx / Labgnostic The National Pathology Exchange - laboratory to laboratory requests and results. See ILW
Regional shared care record For example the Yorkshire and Humber Care Record (YHCR) or an IHE XDS community - see Results Distribution
NHS England Pathology Laboratory Reporting API Validates a laboratory report (FHIR Document) and stores it in Patient Data Manager
Patient Data Manager (PDM) National FHIR store for the reports and their acknowledgements
Multicast Notification Service (MNS) Publishes the test result stored event to subscribed GP systems

Actors and Systems Together

flowchart LR
    subgraph Requester[Requesting organisation]
        OP[Order Placer<br/>EPR / GP order comms]
        ORT[Order Result Tracker<br/>EPR / GP system]
    end
    subgraph Laboratory[Laboratory - trust or pathology network]
        OF[Order Filler<br/>LIMS]
        AM[Automation Manager<br/>LIMS middleware]
        TIE[Trust Integration<br/>Engine]
    end
    subgraph Reference[Reference laboratory]
        SC[Subcontractor<br/>LIMS]
    end
    subgraph National[NHS England]
        API[Pathology Laboratory<br/>Reporting API]
        PDM[(Patient Data<br/>Manager)]
        MNS[Multicast Notification<br/>Service]
    end
    OP -- "LAB-1 OML^O21" --> OF
    OF -- "LAB-2 OML^O21" --> OP
    OF -- "LAB-3 ORU^R01" --> ORT
    OF -- "LAB-35 OML^O21" --> SC
    SC -- "LAB-36 ORU^R01" --> OF
    OF --- AM
    OF -- "ORU^R01" --> TIE
    TIE -- "ORU^R01" --> OP
    OP -- "FHIR Document<br/>(GP order comms)" --> API
    API --> PDM
    API --> MNS
    MNS -- "event" --> ORT
    ORT -- "retrieve report" --> PDM