England Pathology and Laboratory Medicine (PaLM) Technical Framework - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Aim

This guide is an England Pathology and Laboratory Medicine (PaLM) Technical Framework. It takes the IHE Pathology and Laboratory Medicine (PaLM) Technical Framework

• its actors, workflows and transactions - and localises it for interoperability in England:

• HL7 v2.5.1 for the messages laboratories, order communications, EPRs and GP systems already exchange (OML^O21, ORU^R01, ACK), following the IHE PaLM transactions and the conventions of the NW GMSA HL7 v2 standards and the Digital Health and Care Wales HL7 ORU_R01 2.5.1 Implementation Guide
• HL7 FHIR R4 for the same content, as FHIR Messages (the HL7 v2 equivalent) and FHIR Documents (the form used by the NHS England Pathology and Laboratory Medicine Reporting FHIR API)
• how to map between the two, so a trust, network or supplier can run HL7 v2 and FHIR side by side and convert between them

Like the NW GMSA FHIR IG, it supports both HL7 v2 and FHIR rather than choosing one.

Scope

In scope:

• Laboratory orders and results for the specialisms covered by the NHS England Pathology and Laboratory Medicine Reporting standard (DAPB4101): clinical biochemistry, haematology, immunology, transfusion medicine and microbiology (bacteriology, virology and serology)
• Ordering and reporting within a trust (EPR / order communications to LIMS), to primary care (LIMS to GP system), and between laboratories (pathology networks and reference laboratories)

Out of scope (for now):

• Cellular pathology and genomics reports - see the Cancer Pathology Report proof of concept and the NW GMSA FHIR IG
• Laboratory device automation (IHE LAW, LDA), labelling (LBL) and point of care testing (LPOCT) - outlined on IHE PaLM in England only

Content

Analysis and Design (Volume 1)

• IHE PaLM in England - the IHE PaLM profiles and how they apply in England
• Actors and Systems - IHE actors and the NHS systems that play them
• Laboratory Testing Workflow (LTW) - ordering and resulting within and between organisations
• Inter-Laboratory Workflow (ILW) - pathology networks and referral (reference) laboratories
• Results Distribution in England - how results reach the requester, the GP record and shared care records

Interactions (Volume 2)

• Placer Order Management [LAB-1], Filler Order Management [LAB-2]
• Order Results Management [LAB-3]
• Sub-order Management [LAB-35], Sub-order Results Delivery [LAB-36]
• NHS England Pathology Laboratory Reporting API - the national FHIR API, Patient Data Manager and the Multicast Notification Service event
• NHS England Examples as HL7 v2 - the NHS England Pathology FHIR IG examples as ORU^R01

Data Models (Volume 3)

• FHIR Resources - the profiles and how they relate to HL7 Europe Laboratory, UK Core and the NHS England Pathology FHIR IG
• Terminology - SNOMED CT (PaLM), LOINC, UCUM and HL7 v2 tables

HL7 v2 and Mapping (Volume 4)

• HL7 v2.5.1 Segments and Data Types - the England localisation of MSH, PID, PV1, ORC, OBR, TQ1, NTE, OBX, SPM and MSA
• Mapping HL7 v2 and FHIR - message, segment, data type and vocabulary mappings in both directions

Notebooks (in the GitHub repository)

• 01-oru-r01-to-fhir-message.ipynb - converts the ORU^R01 examples into FHIR Messages
• 02-fhir-message-to-fhir-document.ipynb - converts the FHIR Messages into FHIR Documents for the NHS England API, including the human readable narrative

Example

One scenario runs through the guide: a GP at Example Surgery (ODS A12345) requests a full blood count for Octavia CHISLETT (NHS Number 9449305552) from the Manchester University NHS Foundation Trust (ODS R0A) laboratory.

Sources

• IHE PaLM Technical Framework - Volume 1 (profiles), Volume 2 (transactions), Volume 3 (content)
• NHS England - Pathology and Laboratory Medicine Reporting FHIR API and the NHS England Pathology FHIR Implementation Guide
• NHS England - Pathology and Laboratory Medicine Reporting: Test Result Stored Event
• NW GMSA - HL7 v2 Standards
• Digital Health and Care Wales - HL7 ORU_R01 2.5.1 Implementation Guide (v2.0.0 STU, approved 22 March 2023)
• HL7 Europe Laboratory Report 2.1.0 and HL7 Europe Base and Core 2.0.1
• HL7 Version 2 to FHIR