Interoperability and workflows
CareOne in your information system, the standards it uses, the imaging and laboratory workflows.
Designed to integrate, not to isolate.
CareOne sits at the heart of your health information system and talks to the applications that make it up.
CareOne within the organisation’s information system
Diagram description :CareOne, surrounded by an “APIs and interoperability” layer, exchanges data with six families of applications: patient administration (HL7 v2, IHE PAM), laboratory (HL7 v2), imaging (DICOM, HL7 v2), documents (CDA R2, CI-SIS), identity (INS via INSi) and other business applications (FHIR R5).
A concrete example: the imaging workflow.
From the order to image viewing and the report.
CareOne, the hospital’s picture archiving and communication system (PACS) and the imaging devices exchange data in six steps, all based on standards.
CareOne
EPR, always the system that orders the examination
- Ordering and scheduling the examination
- Patient identity management: local patient identifier (IPP) and French national health identifier (INS)
- Tracking the examination
- Report and access to images, through the PACS viewer
Hospital PACS
Image storage and worklist management
- DICOM image storage
- Worklist management (DICOM MWL)
- Image viewer
- Standard interfaces: HL7, DICOM, DICOMweb
Modalities
Imaging devices
- CT
- MRI
- X-ray
- Ultrasound
1. Examination orderHL7 ORM / OMI
from CareOne to Hospital PACS
- Patient identity (IPP, INS)
- Order: type of examination, clinical indication, priority
- Scheduling information
2. Identity updatesHL7 ADT, IHE PAM profile
from CareOne to Hospital PACS
- Creating or updating a patient
- Merging duplicates
- Correcting an identity (IPP, INS)
3. Worklist queryDICOM MWL C-FIND
from Modalities to Hospital PACS
- List of examinations scheduled for the modality
- Filters: date, application entity (AE) title
4. Worklist responseDICOM MWL C-FIND, response
from Hospital PACS to Modalities
- Scheduled examinations
- Accession number
- Patient and examination data
5. Examination imagesDICOM C-STORE
from Modalities to Hospital PACS
- Images of the examination
- DICOM metadata: accession number, patient, modality
6. Examination completed and images availableHL7 ORU or DICOMweb
from Hospital PACS to CareOne
- Availability notification (HL7 ORU), or query by CareOne (DICOMweb, using the accession number)
- Access to the images through the PACS viewer, from the accession number
With or without a radiology information system (RIS)
In both cases, CareOne remains the system that orders the examination.
The hospital has no RIS
CareOne takes on its role:
- justification of the examination;
- scheduling;
- tracking of the examination;
- report;
- contrast media.
The hospital has a RIS
The RIS handles the order, scheduling, the worklist, dictation, the report and the dose. CareOne interfaces with it:
- it receives statuses, reports and the procedures performed;
- it keeps billing.
Patient identity in DICOM objects
- PatientID: the IPP, the hospital’s local identifier
- INS: secondary identifier, to be configured according to current recommendations
Additional, optional exchanges
- Examination status: start and end (HL7 ORM / ORU)
- Report (HL7 ORU)
Simplified diagram
- The diagram shows a hospital with no RIS: CareOne takes on its role.
- Here, the PACS also acts as the worklist provider.
Another example: the laboratory workflow.
From the order to the report, CareOne runs the laboratory workflow.
In integrated mode, CareOne runs the workflow itself: receiving the tubes, entering the results, technical validation followed by validation by the laboratory physician, and the report. It connects to the analysers or to their middleware. This mode is in service.
CareOne
EPR and laboratory workflow
- Test ordering
- Care plan: specimen collection
- Receiving the tubes
- Entering the results
- Technical validation, then validation by the laboratory physician
- Report
- Results, history, trend charts
- Alerts on critical values
No middleware in CareOne
Laboratory equipment
Middleware
Drives the analysers, when the laboratory has one
- Dispatches the tests to the analysers
- Quality control
- Reruns, dilutions
On site, next to the analysers
Analysers
Biochemistry, haematology…
- Read the barcode
- Run the tests
- Send back the results
The workflow, step by step
1. Test ordering
In CareOne, by the prescriber
- The order feeds the care plan, which shows the specimen collection
2. Specimen collection
In the care unit
- Each tube is labelled with a barcode
3. Receiving the tubes
In CareOne, at the laboratory
- The laboratory records the arrival of each tube
4. Tests
CareOne and the analysers, or their middleware
- CareOne connects to the analysers or to their middleware
- The results are entered in CareOne
5. Validation
In CareOne, at the laboratory
- Technical validation
- Then validation by the laboratory physician
6. Report and results
In CareOne, in the patient record
- Report
- Results, history and trend charts
- Alerts on critical values
What about the tube?
The labelled tube follows its own path: specimen collection in the care unit, reception at the laboratory, run on the analyser. Its barcode carries the specimen identifier, which is distinct from the order number: one order often produces several tubes.
If the hospital keeps its laboratory system: connector mode
CareOne also provides for a connector mode: it orders the tests and receives the results, and the hospital’s laboratory information system (LIS) carries them out, whatever its vendor.
1. Test order
from CareOne to The hospital’s LIS
HL7 OML^O21, IHE LTW profile (transaction LAB-1)
- The laboratory answers with an ORL^O22 message
2. Patient identity, merging of duplicates
from CareOne to The hospital’s LIS
HL7 ADT, IHE PAM profile
- Local patient identifier (IPP) and French national health identifier (INS)
3. Results validated by the laboratory physician, and report
from The hospital’s LIS to CareOne
HL7 ORU^R01 (transaction LAB-3)
- Tests coded in LOINC, or in local codes with a mapping table
- UCUM units
- Report as a PDF, embedded in the ORU message or sent in an MDM^T02 message
Between the LIS, the middleware and the analysers, the exchanges (IHE LAW, ASTM) are internal to the laboratory: they stay outside CareOne.
In both modes
- CareOne orders the tests and presents the results in the patient record.
- No middleware in CareOne.
In connector mode, to be decided by each hospital
- Who prints the tube label: CareOne at the bedside, or the LIS?
- The format of the order number and of the specimen identifier, end to end.