Electronic Health Record - Action Required
Re: Electronic Health Record – Action Required
To the Canadian Clinical Chemistry Community:
In 2001 the Federal, Provincial and Territorial governments established Canada Health Infoway (Infoway) as a federally-funded, independent, not-for-profit organization, with membership consisting of Canada's 14 federal, provincial and territorial Deputy Ministers of Health. Infoway’s objective is to accelerate the use of interoperable electronic health information systems and electronic health records (EHRs) across the country. The clinical goal is that 100% of Canadians should have an EHR by 2015. To date, approximately $1.2 billion has been invested by Infoway in this venture.
Right from Infoway's founding in 2001, the essential role of standards was well understood and a process was put in place to select appropriate standards for the overall project. After due consideration, LOINC (for Logical Observation Identifiers Names and Codes) was selected as the standard for nomenclature, and SI for units. Based on the then-current version of the LOINC database, a Canadian version (subset) of LOINC was prepared, and identified as pCLOCD (for Pan-Canadian Laboratory Observation Code Database, January 2007).
This database (pCLOCD) contained 31,177 test entries and 33 fields, one of which was designated Recommended Units. Results from about 50% of entries are reported on a quantitative scale – thus implying a numeric value with an associated unit – so the importance of standardization of units is obvious. Regrettably, despite the original commitment to SI, consensus for many tests was not reached, and as a consequence pCLOCD was published with the Recommended Units field blank. However, a recommendation was put forth that the field be completed with the assistance of outside experts. In this context, the Canadian Society of Clinical Chemists was specifically mentioned.
The CSCC Council has agreed to assist Infoway in completing the Recommended Units field of pCLOCD. The primary objective is to produce a revised pCLOCD that will provide the answer to this question:
For this specific test, what result reporting units are recommended?
The intention is that the recommendation will be based on SI principles, tempered modestly by considerations of current practice in Canada. Thus, we do not anticipate that katal will be recommended for catalytic activity, nor pascal for pressure, but we do expect that the SI preferences for mol and litre, and the correct use of decimal prefixes will be respected.
The expertise within CSCC is required to facilitate the transition of laboratory data into the electronic health record. This is a great opportunity for individual CSCC members, CSCC Interest Groups and Divisions to get involved in this vital process. A truly functional, provincially-interoperable electronic health record will demand the use of many standards, not least of which will be standards for the units used in reporting laboratory results. With your help and co-operation, the CSCC can make a major contribution to achieving this goal.
At this time we wish to ask members/groups to identify which area(s) of laboratory medicine they wish to participate in (classifications derived from the journal Clinical Chemistry):
General Clinical Chemistry
Lipids, Lipoproteins, and Cardiovascular Risk Factors
Cancer Diagnostics
Proteomics and Protein Markers
Endocrinology and Metabolism
Clinical Immunology
Drug Monitoring and Toxicology
Urinalysis and Blood gases
Molecular Diagnostics and Genetics
Point-of-Care Testing
Infectious Disease
Any interest, questions, or comments in regards to this process please direct to Peter Kavsak, Head Professional Affairs Division, CSCC (email: kavsak@hhsc.ca). We hope to commence work in this area soon via committees. This will be the first of many reminders/requests in this area and we hope that members from all provinces and territories will be able to contribute in order to ensure uniformity within the country. We thank you in advance.
Sincerely,
Peter Kavsak (CSCC)
Gilbert Hill (CSCC and Infoway)
Lianna Kyriakopoulou (CSCC)
Lorie Carey (Infoway)
Beverly Knight (Infoway)
