VistA Laboratory Enhancement Proposals. Wish List of Improvements and Enhancements to Laboratory Package Functionality
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1 VistA Laboratory Enhancement Proposals Wish List of Improvements and Enhancements to Laboratory Package Functionality
2 Overview Improving Existing Functionality Implementing Enhancements Support New Functionality Core Database Redesign Support External User Interface
3 Long-term goal Correct Existing Defects/Deficiencies Support Functionality Needed by Non-Governmental Sector Support Current and Emerging Legal and Clinical Requirements Implement and Support Data Standardization and Interoperability with External Systems
4 The Present Situation Current Database Design based on original requirements. Single Laboratory Model Slow/Incremental Technological Change Limited Laboratory Testing Compendium Adjunct to Paper Record System Simple Customer Model Ordering Provider
5 Development up to present Defect Correction Limited to Fixing Defects No Refactoring to Reflect Current Knowledge/Conditions Enhancements When Necessary Usually Limited to Immediate Requirement Loss of Domain Experts Maintenance Minimized in Anticipation of New Replacement System
6 Development up to present Laboratory Technology Continues to Advance at Rapid Rate Historical Categorizations Changing Boundaries of Classical Laboratory Areas are being redrawn/eliminated by new technology Test performed previously in Microbiology may now be performed in Chemistry
7 Potential Alternatives Continue Current Band-Aid Approach Small Incremental Fixes Leave Current Database/File Structure in Place Refactor Current System to Support New Functionality and Phase In Database Design Changes with Existing Database Redesign Existing Database to Support Existing and New Functionality
8 Areas for Enhancement Refactor existing functionality in areas of normal ranges, units and abnormality determination. Normal ranges based on multiple age/sex/race Normal ranges based on other factors gestational age, therapy. Support normal ranges for non-numeric results negative (normal)/positive(abnormal) Support additional abnormal flags - normal, abnormal, significantly worse
9 Areas for Enhancement Auto-verification of Automated Instrument Testing Accept auto verified results from middle ware/automated instrument Develop auto-verification functionality within VistA based on specified business rules when no external system Support Linking Images to All Areas of Laboratory Package. Link/store images and binary documents for Chemistry/Hematology/Microbiology areas Linking images at multiple levels specimen, test, component.
10 Areas for Enhancement Support Phlebotomy Collection System Transmit Orders Process Request for Collection Transmit Collection/Accession Information Adjunct/Replacement of Lab Data File (#63) Support Multiple Standard Code Systems LOINC, SNOMED, CPT at multiple levels Support Textual/Word Processing Results Support Comments/Notes and Supporting Information (User, Date/time, etc.) at Analyte Level Support for Semi-Quantitative Results (Titers, Structured Numeric).
11 Areas for Improvement Urgency File Allow inactivation of existing urgencies Label Printing Print label to multiple printers Allow printing to all members of a hunt group Delta Checks Allow days back at test level Override system setting Record Date/Time Order Placed Record Date/Time Order Requested For
12 Areas for Improvement Historical Tests/Results Flag that they belong to an Active panel for Display/Lookup purposes. Would not be Orderable Audit Trail Capability Maintain a formal structured record of changes Who, What, When, Why Expand Lab Universal Interface Support Microbiology Instrumentation Support Anatomic Pathology Processing and Transcription Systems. Expand Point of Care Interface Support Existing Orders on VistA
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