Concept explainer
Laboratories and analysers
Covers results from a laboratory system over HL7 v2, direct analyser feeds over ASTM and outside laboratories, and how each result reaches its order.
Pensieve takes laboratory results from a laboratory information system over HL7 v2, from analysers connected to the bridge over ASTM, and from outside laboratories that run Pensieve themselves. This page traces each route to the order a result belongs to, and sets out what happens to the result once it arrives.
What flows
Every route ends at an order in Forge, the tool that places orders and tracks their results. A laboratory system reaches Pensieve through orophin, the bridge, and so does an analyser that has no laboratory system in front of it.
| Exchange | Direction | Standard | Owning tool |
|---|---|---|---|
| A laboratory order | Out of Pensieve | ORM^O01 or OML^O21 as a command over the bridge, or ServiceRequest with Specimen in a FHIR R4 bundle over a direct connection | Forge |
| The laboratory's acknowledgement and status changes | Into Pensieve | ORR^O02 or ORL^O22, and order messages that report a status | Forge |
| A result from a laboratory system | Into Pensieve | ORU^R01 over MLLP, or a final FHIR R4 DiagnosticReport with its Observations | Forge |
| A critical value | Into Pensieve, beside its result | A panic flag in OBX-8 | Sentinel |
| A result from an analyser | Into Pensieve | ASTM E1381 and E1394 over TCP | Forge |
| A result from an outside laboratory that runs Pensieve | Into Pensieve, through that laboratory's own bridge | Its laboratory system's feed into its own Pensieve site, synced to the order | Forge |
The order's path to the laboratory, and the acknowledgement that comes back, are traced in hospital information systems.
Results from a laboratory system
A laboratory system sends each result as an ORU^R01 to the bridge's HL7 listener, on port 2575 by default. The laboratory results and orders pack maps it as below, and the connection's own rules override any field the laboratory places differently.
| Field | Meaning | Where it lands |
|---|---|---|
| OBR-3 | The accession | The reference that leads the result to its order |
| ORC-2 | The placer order number | Checked against the number Pensieve gave the order |
| ORC-3 | The filler order number | A further key for the match, where the laboratory sends one |
| OBX-3 | The test observed, in the laboratory's own code | Translated to LOINC, with the laboratory's code and text kept beside it |
| OBX-5 | The value | Held to the decimal places the laboratory reported |
| OBX-6 | The unit | Validated against UCUM |
| OBX-8 | The abnormal flag | Normalised onto the result, and a panic flag of LL, HH, AA, CH or CL also raises a critical-value fact |
| OBR-22 | The time the laboratory reported the result | The reported time shown with the result |
The match depends on the accession. A result that arrives without one fails validation and is held for review, and the laboratory system reads that verdict in reply.
A laboratory system that speaks FHIR sends a final DiagnosticReport with its Observations, which map onto the same kind of result. HL7 v2 lists the segments behind these fields and the verdicts a laboratory system reads back.
The result on the order
Once mapped, the result fills the order's result form, a Glyph form attached to the patient's record in Atlas. A typed fact then moves the order's result in Forge from awaited to received. Clinicians read a received result as the laboratory sent it, with its units, ranges and flags, and its values stay closed to editing.
A received result still waits for a person
A received result becomes the trusted result once a person holding the right to verify confirms it. For a result keyed in by hand, Pensieve refuses verification by the person who entered it, as record a result shows.
Until it is confirmed, the result appears on its order, in the record and among the results awaiting verification. When the laboratory system sends a corrected result, the correction becomes the version clinicians read, and the earlier one is kept on the order, marked as superseded. The rules every correction follows are in laboratory and imaging orders.
A panic flag on any line of a result raises a critical-value fact alongside the result's own fact. Sentinel acts on it, raising the alert and following it until a clinician acknowledges, as critical results describes.
Analysers on the bridge
An analyser that reports straight to the bridge connects over TCP on the hospital network, on port 2576 by default. The bridge runs the ASTM E1381 link with it. The E1394 records it receives are kept as one raw block, sealed into the encrypted queue before the platform reads them.
A frame that fails its checksum or arrives out of sequence is answered with a NAK and sent again. A link that stays silent past its timeout, or keeps failing, is released. The link carries results in one direction, from the analyser into Pensieve.
On the platform, the header, patient, order, result, comment and terminator records are parsed. Each result then maps into the record against its order and follows the track of any received result, from received to verified by a person.
Outside laboratories
When an outside laboratory runs Pensieve, its laboratory system reports through its own bridge into that laboratory's own site. Each result for an order placed at the hospital lands on that order and advances its state.
The laboratory's staff work from a console in Westron, where some roles view orders and others update their state. The record's permissions decide what each side may read.
When the laboratory runs other software, the clinician learns at order placement that the result has no automated return. The result is entered against the order later, or uploaded as a report.
Configuring the connection
The laboratory system and the analyser feed are separate connections in Westron, both carried by the site's bridge. Each starts from a preset for its family, LIS or analyser. The analyser feed is also tied to the bridge's ASTM listener.
An operator granted the connections capability defines each one. Both carry their traffic on the bridge's mutually authenticated link. The laboratory system's connection goes live only after the laboratory's own sample results pass a dry run on a sandbox site.
Common confusions
Does a critical value wait for verification before anyone is alerted?
The critical-value fact is raised as the result is mapped, so Sentinel raises its alert while the result itself still awaits a verifier. The verification and the alert run side by side.
Which route should an analyser take when a laboratory system already serves it?
The route through the laboratory system. Its results reach Pensieve over HL7 v2 with the accession and order numbers that system holds, and the ASTM link serves analysers that no laboratory system collects from.
Does a result from a laboratory system need the accession if it carries the placer number?
It does. A result that carries a placer or filler number but no accession is still held for review, and the acknowledgement tells the laboratory system so.
Read how a result becomes a typed fact in from message to record, and how studies reach their imaging orders in imaging.