Laboratory Test Order Workflow

Complete workflow from lab test ordering by provider through specimen collection, testing, and result reporting back to the clinical team

Flow

Laboratory Test Order Workflow

This flow documents the complete journey of a laboratory test from provider order through testing and result reporting, including critical value handling.

Flow Overview

The lab order workflow is one of the most common clinical workflows in healthcare. It demonstrates the integration between EHR, laboratory systems, and clinical decision support.

Key Steps

1. Order Entry

  • Provider orders test with clinical context
  • Diagnosis (ICD-10) for medical necessity
  • Order appropriateness checking
  • Duplicate test prevention

2. Safety Checks

  • CDS (Clinical Decision Support) rules applied
  • Allergy checking (contrast media)
  • Fasting requirements communicated
  • Prior authorization if needed

3. Order Transmission

  • HL7 v2 ORM message sent to LIS
  • Order appears in LIS work queue
  • Specimen labels printed

4. Specimen Collection

  • Patient identification (two identifiers)
  • Specimen collection by phlebotomist
  • Barcode labeling for tracking
  • Chain of custody maintained

5. Laboratory Testing

  • Specimen analyzed by automated systems
  • Quality control checks performed
  • Results validated by lab staff
  • Critical values identified

6. Result Reporting

  • HL7 v2 ORU message sent to EHR
  • Results integrated into patient chart
  • Provider notification
  • Patient portal access (after provider review)

7. Clinical Action

  • Provider reviews results
  • Clinical decisions made
  • Treatment initiated if needed
  • Follow-up arranged

Critical Value Process

For life-threatening results:

  1. Immediate Identification: LIS flags critical value
  2. STAT Notification: Provider paged immediately (page, SMS, call)
  3. Acknowledgment Required: Provider must acknowledge receipt
  4. Escalation: If no response in 15 min, escalate to attending/supervisor
  5. Documentation: Notification time and recipient documented
  6. Clinical Action: Provider initiates immediate treatment

Turnaround Time Targets

PriorityTarget TATUse Case
STAT1 hourLife-threatening conditions
URGENT4 hoursED, urgent care
ROUTINE24 hoursOutpatient, non-urgent
SEND-OUT3-7 daysReference lab testing

Common Lab Tests (LOINC)

  • CBC: 57021-8 (Complete Blood Count)
  • BMP: 51990-0 (Basic Metabolic Panel)
  • CMP: 24323-8 (Comprehensive Metabolic Panel)
  • Lipid Panel: 57698-3
  • HbA1c: 4548-4 (Diabetes monitoring)
  • TSH: 3016-3 (Thyroid function)

Quality & Safety

Error Prevention

  • Right patient (two identifiers)
  • Right test (LOINC code verification)
  • Right specimen (tube type)
  • Right time (collection time recorded)

Quality Control

  • Daily QC on analyzers
  • Proficiency testing
  • Delta checks (compare to previous)
  • Reflex testing protocols

Integration Standards

  • HL7 v2.5/v2.7: ORM (order), ORU (result)
  • LOINC: Test identification
  • SNOMED CT: Clinical findings
  • FHIR: DiagnosticReport, Observation (future)

Patient Experience

  • Transparency: Patients can view orders in portal
  • Instructions: Pre-test instructions provided
  • Results: Available 24-48 hours after provider review
  • Education: Links to educational materials
  • Patient Admission
  • Prescription Fulfillment (if treatment initiated)
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