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Oncological blood tests interface

Meuhedet HMO, Sheba medical center, Outburn Ltd.

Oncologist patients are required to arrive at the hospital with up-to-date blood test results, which were taken at the HMO’s clinic, to get treatment.

These days the treatment administration occurs without any direct contact between the the HMO and the hospital - the hospital issues a referral for lab tests, and the patient must take the tests (sometimes going through the family doctor itself to ask for the HMO’s referral) and to arrive with up-to-date results at the hospital to get the treatment.

Should the patient arrive without the results or with invalid results (15% of all results are invalid), the patient won’t be able to get the treatment at all or would have to take the tests again at the hospital, while waiting a long time for the results (40% of the patients actually have the tests at the hospital).

As part of the project, a FHIR based interface is created between the HMO and the hospital, through which the blood tests can be ordered directly from the hospital to the HMO, and the results are also received to the hospital in a condensed form in advance, which allows to determine whether the patient’s appointment should be postponed.


The group’s study case

  • Transferring a proactive request from the hospital to the HMO in order to create a lab tests referral for an oncologist patient within a predefined period  of time before the scheduled treatment

  • The HMO receives the request, and automatic referrals for the requested blood tests are accordingly created in the HMO’s systems, without the patient’s action or engagement needed. Thereby, the patient and his family are being spared of the  bureaucracy in times of complicated health condition

  • The hospital is notified when the referrals are successfully created  

  • The patient arrives for blood tests. His consent is being checked in the HMO’s systems.

  • Given the patient's consent, the blood tests results are transferred to the hospital in real-time

  • A digital examination of the test results (according to a limit set by the attending oncologist). If the test is valid - an automatic message is sent to the patient, approving his arrival to treatment. If the test is invalid - marking the test and passing it to the careteam attention

  • Creating hospitals mechanism - in which the careteam (doctor/nurse) will go through the abnormal results, and inform the patient about the actions he has to take (such as: attending ER, re-taking the tests, postponing the treatment, etc.). The staff member will document the actions made and instruct the patient accordingly


The project’s world of content

  • Profiles of lab tests - CBC, blood chemistry, lever function, thyroid function, clotting function

  • Day care oncology treatments

  • Blood tests referrals

  • Consent


Solution’s Architecture

  • From Sheba’s end - Health Share Health Connect (HSHC) is checking for the booked appointments, retrieving treatment plans and sending requests for referrals to Meuhedet. Later in the process HSHC is handling all updates and results coming from the HMO in FHIR Facade configuration.

  • From Meuhedet’s end - the requests for referrals are arriving to (HAPI) FHIR Server.

  • HAPI is approaching Meuhedet’s systems to drive a process of creating referrals through TIBCO BW.

  • The blood test results are coming from the Meuhedet lab system which will inform the HAPI

  • Validation will not be executed in production environment on the first step


Profiles to be characterized in the project

  • Blood tests results (single test and or battery) - Observation

  • Conclusion / report of blood tests results and status - DiagnosticReport

  • Request for referral to lab tests - ServiceRequest


Terminology to be used

  • Lab tests codes LOINC


Project Status

  • Process characterization, end to end, including modeling of the solution based on FHIR - completed.

  • The interfaces on Meuhedet’s end are on development, scheduled completion - 1st quarter, 2023

  • The interfaces on Sheba’s end and establishment of dashboards to care givers are in development, scheduled completion - 1st quarter, 2023

  • Alongside with development, a pilot with 15 patients is planned, as the consent process is being discussed with the legal sources of the organizations

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