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Re: [Gnumed-devel] Matching was Re: Mirth (2 of 3): HL7 import for the G

From: Jim Busser
Subject: Re: [Gnumed-devel] Matching was Re: Mirth (2 of 3): HL7 import for the GNUmed project - test source message
Date: Tue, 17 Aug 2010 07:53:46 -0700

On 2010-08-17, at 1:25 AM, Karsten Hilbert wrote:

>> the only reason i overloaded encounters was because there was no
>> other way to preserve the OBR-OBX hierarchy.  place something in the
>> database that i can use and i'll use that instead.
> I do realize that and we will put something in the database. What you did
> there was fine for the time being.
> Now we need to find out what the OBX-OBR link IS in clinicians terms.

So we are maybe determining whether an operational requirement (namely, to be 
able to logically relate incoming results, to any results that are already 
existing) has a clinical meaning, or whether it needs to live somewhere to the 
side of the clinical data, in order to not confuse the clinical data with a 
non-clinical meaning?

Let us see...

- the OBX is a single instance, of any one test result, of a certain test type, 
transmitted inside exactly one OBR
- the OBX does contain a provision for (it contains a field) subid where 
multiple "lines" of a result (each of which carry the same LOINC) need to be 
provided, for example when the LOINC is "Pathologist's comments" or when the 
LOINC is "Urine culture" there may arise more than one comment or more than one 
bacteria/organism within the result... if I recall correctly there was a 
feeling that this subid might a technical device --I am just wildly 
hypothesizing here --- e.g. to better support the inflow of data and that in 
place of GNUmed supporting the subid within the GNUmed result table, such data 
could just be concatenated (maybe with line feeds) in a single pooled text 
field. But this was not the question, though the context is maybe still 

- what the above does not provide for is when a single instance of a LOINC test 
is performed more than once, say... blood cultures which are often taken just 1 
or 5  or 10 minutes apart. These need to be kept distinct and I suspect that 
even if the lab were provided a single piece of paper, they may create three 
individual OBX because the OBR need to be kept distinct. Another situation 
could be where the patient is sent back to the lab a second time on the same 
day, the OBR is part of what keeps these *operationally* distinct but did not 
yet achieve special meaning.,,

But I *do* think there remains a clinical meaning because the OBR captures the 
level of the collector of the specimen plus the specimen itself (from which 
some multiple of test results were derived) and also which bench of the lab 
(immunology, chemistry etc) of the lab. So the clinical value of this 
information is when you either need to trace which part of the lab to talk to 
in order to get more information about a result, and also in the situation 
where a having-to-explained observation depends on which specimen it came from. 
Maybe a patient gave 3 tubes of blood but one tube which turned out to come 
from a different patient had been mislabelled. When the lab is contacted and 
understands we have results from a wrong tube, as soon as you detect one result 
that cannot belong to this patient, you can know which other results to reject 
as relating to this same specimen. 

-- Jim

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