Pathology Report Messages

Hi,

I’m now starting to work on a proof of concept to implement the transmission of Pathology Messages to GPs via MESH, however I’m struggling to find the specification for this kind of messages.

There is some information in the NHS Digital website (https://digital.nhs.uk/diagnostics-data-service/pathology-report-messaging) but it’s everything very high level and no technical information is provided.

I also found some references to “ISB1557 EDIFACT Pathology Messaging” that apparently is been replaced to HL7 FHIR messages but one more time all the links for technical specifications were not found or didn’t work.

I’ve found a couple of Pathology messaging specifications (using HL7 messages) used in other countries such as US and Australia but nothing about UK.

Can anyone point me some documentation\resources where I can get some information about this subject?

Many thanks

I don’t believe the UK issued any central guidance on the use of HL7v2 for pathology but HL7v2 is used quite extensively to send reports to GP’s via MESH (formerly known as DTS).

I’ve used the IHE guides to help me understand the process (and details of the HL7v2 messages) http://wiki.ihe.net/index.php/Laboratory_Testing_Workflow

These are the docs I think you’re looking for in relation to Pathology Messaging proposed move to FHIR. Draft Primary Care Path Reporting Message Change Strategy https://developer.nhs.uk/downloads-data/draft-primary-care-path-reporting-message-change-strategy/ And ‘work in progress’ FHIR Implementation Guide for Diagnostic Services located here https://data.developer.nhs.uk/fhir/dds-draft-b/DDS-Version-1-0-Draft-B/Chapter.1.About/index.html the link from this page https://developer.nhs.uk/downloads-data/fhir-dds-dms/ should be pointing at previous link but look to be incorrectly pointing at a different Social Care Documentation FHIR Message Specification. Further documentation on Diagnostic Data Services FHIR Profile Design here https://developer.nhs.uk/wp-content/uploads/2016/03/DDS-FHIR-ProfilesDesign.pdf

Many thanks for your replies…

Additionally to the links you have recommended I also found very useful information in the following resources:

One of the goals of the POC we are working on is to send this kind of messages to INPS Vision to be handled by their Mail Manager module.

@benmcalister, @mayfield.g.kev Do you have any experience with this kind of use case? Or do you know any good source of information about this subject (I’ve dropped an email to Vision but I don’t know if I’ll have any answer from them)?

The (English) trusts I worked at, all sent their (HL7v2) Results to the ICE OrderComms software which dealt with delivery to GP’s.

We did use the ITK HL7v2 messages (but not the XML format), this was for Patient and Encounter management.

FYI I’m working on a poc which is viewing results/orders from a mobile/other device using FHIR RESTful API (rather than messaging), it’s using FHIR profiles from the FHIR Messaging in https://nhsconnect.github.io/NHS-FHIR-DDS/Generated/Chapter.1.About/index.html

which dealt with delivery to GP’s.

and this happens by translation from HL7v2 to PMIP EDIFACT format.

Rik

In our situation there is no ICE OrderComms involved. The ideia here is to have a 3rd party application sending a simple message with clinical codes (Health Check data) to update a patient into the GP clinical system.

This integration with the GP systems is a little bit tricky because they don’t provide a really open API that we can use, so we are using pathology messages with Mail Manager for Vision and for Emis Web we are looking to send the messages via their Keystone messaging interface.

Regarding your poc I am assuming that you are using a REST API because the device already exposes that API , am I right?

No, we’re looking at how the problem can be sorted by an API. So mobile devices and possibly other systems who didn’t receive the lab report via normal methods.

@riksmithies have asked around and the ex-TPP/EMIS experts here all agree it was a mix of formats.

Curious why they haven’t suggested DTS/MESH. This diagram matches my understanding of the process

https://nhsconnect.github.io/NHS-FHIR-DDS/Generated/Chapter.3.FHIR%20Messaging%20Implementation/index.html

The payload either being HL7v2/EDIFACT and in the future FHIR.

@mayfield.g.kev I just spoke about the Keystone messaging interface because from my initial research it seems to be the easiest way to interact with EMIS, but maybe I am wrong (my knowledge on these subjects is minimal - GP system and NHS interoperability system in general).

From your comment I can assume that it will be possible to use DTS\MESH to delivery the messages to EMIS. If so, can you give me some more information about it?

Can I also have your comment about what I am tying to achieve with my poco and if my assumptions are the best way to implement it.

So, lets assume the following simple scenario:

Use Case: Send a message with clinical data (a few clinical codes and their values) to the GP system in order to allow the GP user to add “automatically” the information to the patient record.

Message: Because I know that the digital reporting of pathology test results are very common and that kind of messages can be used to communicate the data I need to send (health checks data). My ideia is to use this kind of messages, technically I am looking to the following messages:

HL7 v2 :: ADT - A31 (Update Patient Information) – Observation/Result
FHIR :: Observation and DiagnosticReport resources

Transport: Use MESH to delivery the messages

GP Systems: Process the messages in the following GP systems:

Vision :: via Mail Manager module (according to their documentation: "Health Check data received via the
pathology message route can now be filed into the patient record in the usual way using the Read codes received" )
EMIS Web :: via Keystone (this needs more investigation :thinking: )
SystmOne TPP :: TBD (but maybe using the same approach used to process the pathology messages)

I’ve been struggling to find documentation regarding how the GP systems are consuming pathology messages or other DTS\MESH messages in general.

Can I have your opinion\comments regarding the assumptions\decisions above?

What I’m working from is a HL7v2 ORU^R01 message like this https://corepointhealth.com/resource-center/hl7-resources/hl7-oru-message

The ADT^A31 is normally used to alter Patient demographics, nothing else. The ORU^R01 also carries patient demographic information, which should be enough for a GP system to match the patient. So I don’t believe you would need an A31.

I think you would need to speak to GP suppliers to get more details.

Hi Jorge
Please can we discuss where you got to with your POC? I’m looking a something very similar
Thanks
Michelle

Looks like EMIS use something called ASTM Knowledge Base - Customer Support

ASTM is what lab analysers tend to speak natively - very low level. It pre-dates even HL7 V2, and I think some of V2 was actually based on it. That doesn’t sound like a good format to target these days. I thought only Lab systems tend to use that, converting it to V2 to talk to PAS etc.

The other format mentioned there, MEDRPT, is the name of the format used by GP PMIP messages (aka ISB1557 EDIFACT Pathology Messaging).

Basically to get lab in to GPs you would probably want to use PMIP messages at the moment (they have all supported that for 20 years), until FHIR gets adopted one day, but there are no formal plans for that that I am aware of.

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