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Re: [Gnumed-devel] More lab test result considerations: groupings

From: lkcl
Subject: Re: [Gnumed-devel] More lab test result considerations: groupings
Date: Sun, 8 Aug 2010 14:30:04 -0700 (PDT)

Jim Busser wrote:
> I am realizing a problem GNUmed will suffer in BC, CA (very possibly  
> elsewhere as well) where, until all parts of the request had become  
> finalized, it is possible that one or more tests could get cancelled  
> or recoded or deleted, communicated only in the more-general level  
> OBR without the detail of the specific OBX that we would have already  
> imported being re-provided.
> One example would be a value that was originally reported as a random  
> glucose, becoming reclassified as a fasting glucose. While the lab  
> will re-issue an OBR for the original test code "random glucose"  
> indicating that it had been X-revoked, the lab does not re-issue the  
> OBX detail. It only supplies a new OBR and OBX for the seemingly-new  
> fasting glucose.

again, found this from doing a search, but it's relevant still, so even
after so long i'll pick it up.

could you possibly clarify, preferably with a pair of example HL7 datasets,
exactly what action should be taken?  at the moment, business/ has
no provision for deleting of clin.lab_request or of clin.test_data records:
there is only provision for *overwriting* should there be an accurate match,
based on (ORC003 filler_order_number + lab name) for clin.lab_request, and
(ORC003 + lab name) + (OBX003 test_type + OBX004 sub_id) for clin.test_data.

so - questions:

1) OBX11 (observation result status) is being completely ignored in
right now.   do you want me to do a "delete if == X"?

2) would it be better if clin.test_data had a database field indicating the
status of the test result?  i.e. do you want to _know_ that the result was

3) in the "new" result (i.e. once an HL7 message with "delete me" OBX11=='X'
has been actioned) is the OBR code (OBR 003 filler_order_number) changed or
does it stay the same as in the previous message?

4) in the case where the OBR 003 stays the same (if indeed it does), which
is received first: the "delete me" or the "new superceding result)?

or - worse, does it vary?  are there cases where the receipt order of the
two changes around?  should this be catered for by double-checking the
timestamps?  are the timestamps actually _correct_? :)

etc. etc.

so - it would be reaally good to see some examples containing HL7 messages
that perform initial create, then delete, then "add replacement".  in
particular it would ease my mind to see those messages actually containing
ORCs rather than just containing OBXs, because if they _just_ contain OBXs
with no associated ORC, finding out which clin.test_data row is to be
deleted would, um... be a bit of a pisser.


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