Proposed LOI and LRI IG Implications of Cancel scenarios below
1) Until specimen is received in laboratory ,
a. provider may cancel test [LOI cancel transaction]
b. Laboratory may cancel test if unable to obtain acceptable specimen (e.g. patient did not show , unable to draw) [what is the
correct transaction? LOI status, LRI or LRI cancel]
2) Once laboratory has received requisition and specimen
a. Provider may request cancel [LOI cancel transaction?]
b. Laboratory may cancel if unable to perform test (e.g. unacceptable specimen) [LOI status or LRI cancel]
3) Once any result has been reported to provider
a. Provider man not request cancel
b. Laboratory may not cancel once any report has been issued to the provider (preliminary, partial, final, …). If there is a problem
with completing the testing (e.g. reflex, final, …) the appropriate comment is sent and provider is called [LRI only]
Cancellation Scenarios and Actions for both Provider and Laboratory
Our role is to support the development of HL7 LOI and LRI Implementation Guides that support the IT functionality laboratories will need for
their practices. We should not prescribe workflow or business practice as these are determined by each individual laboratory. There are always
exceptions and if we really want to determine practice on the cancellation process, then we should have that discussion. If we are saying that a
laboratory would never cancel the order of a resulted test and that any reported result must always remain in the record, then we can make that
recommendation. See proposed edits in red below to stimulate discussion.
In summary, this table suggests:
 For provider collected specimens, providers can cancel a test request in the EHR from the time of order until the LIS indicates a receipt
date and time
 For laboratory collected specimens, providers can a cancel test request in the EHR from the time of order until the LIS indicates a collect
date and time
 Providers can send a “cancel request” for a pending test after the option to cancel a test request in the EHR is no longer available.
 Providers cannot send a “cancel request” once a preliminary or final test report has been received in the EHR
 Laboratories can cancel a test request received by the LIS (or queue for this purpose) any time before the test report (preliminary or
final) is transmitted to the provider(s)
 Laboratories cannot cancel a test (and accompanying test results report) once a preliminary or final test report has been transmitted to
the provider’s EHR
Information process step
(timeline)
Status/Scenario
Cancelled by Provider
Cancelled by Laboratory
Given the scenario, how should the
cancellation be handled by the EHR?
Given the scenario, how should the
cancellation be handled by the EHR?
Provider staff cancels the order in the EHR
or can convert the order to “Laboratory
collect”.
(No specimens; no order in lab)
Scenario continued: The patient’s mother
refuses to take the patient to the
laboratory for specimen collection.
Scenario continued: The patient does not
appear at the laboratory for collection
(within a certain timeframe?) or the
laboratory is unable to collect the blood
specimen.
1 Tests ordered in EHR
Provider collect
 Tests have been ordered in the
provider EHR
 Specimens have not been collected
 Test request has not been sent to lab
Scenario: Pediatrician orders a CBC on a
3 year old boy. The office staff is unable
to collect the blood specimen.
Laboratory collect
 Tests have been ordered in the
provider EHR
 Specimens have not been collected
 Test request has been sent to lab
Scenario: Pediatrician orders a CBC on a
3 year old boy. The patient is referred
to a local laboratory for specimen
collection.
2
Provider staff can cancel the order in the
EHR.
N/A
Laboratory staff can cancel the order in
the LIS, which in turn cancels the order in
the EHR. The physician is notified of the
cancellation, the reason, and of any
guidance the laboratory may provide.
Specimen collect time
updated
Provider collect
Collect time entered in EHR
May occur simultaneous with
step 1 - ordering
Laboratory collect
Collect time entered in LIS
May occur simultaneous with
step 3 - receipt of specimen
in in LIS
 Tests have been ordered in the
provider EHR
 Specimens have been collected by
the provider
 The specimen collect time has been
recorded in the EHR
 Test request has been sent to lab
Scenario: Pediatrician orders a CBC on a
3 year old boy. The office staff collects
the blood specimen.
 Tests have been ordered in the
provider EHR
 Test request has been received by lab
 Specimens have been collected by
the laboratory
 The specimen collect time has been
Scenario continued: The physician
recognizes a CBC was done earlier that day
when the patient was in the local
emergency room and chooses to not send
the specimen collected in the office to the
laboratory for testing.
Provider staff can cancel the order in the
EHR.
Scenario continued: Before the specimen is
received by the testing location, the
physician recognizes a CBC was done
earlier that day when the patient was in
the local emergency room and does not
want to duplicate the testing.
Scenario continued: Specimen processing
staff in the laboratory recognize the
specimen was collected in the wrong tube
and reject it before the sample status is
updated to “received” in the LIS.
Laboratory staff can cancel the order in
the LIS, which in turn cancels the order in
the EHR. The physician is notified of the
cancellation, the reason, and of any
guidance the laboratory may provide.
Scenario continued: Before the specimen
is sent to the testing location,
phlebotomy staff at the draw station
recognize the specimen is clotted.
recorded in the LIS
Scenario: Pediatrician orders a CBC on a
3 year old boy. The patient is referred
to a local draw station, the specimen is
collected, and the time is updated in
the LIS.
3 Specimen received in LIS
4 Specimen analyzed
5 Test results reported in LIS
Scenario: Pediatrician orders a CBC on a
3 year old boy. The blood specimen
was collected (by either the provider or
the laboratory).
Scenario: Pediatrician orders a CBC on a
3 year old boy. The blood specimen
was collected (by either the provider or
the laboratory), received at the
laboratory, and testing initiated.
Scenario: Pediatrician orders a CBC with
diff on a 3 year old boy. The blood
specimen was collected (by either the
provider or the laboratory), received at
the laboratory, and testing initiated.
Provider staff can send a cancel request to
the laboratory, but cannot cancel the order
in the EHR after the draw station or
laboratory has recorded a collect and/or
receipt time.
Laboratory staff can cancel the order in
the LIS, which in turn cancels the order in
the EHR. The physician is notified of the
cancellation, the reason, and of any
guidance the laboratory may provide.
(NOTE – how is a reorder/recollect
handled?)
Scenario continued: After the specimen
has been sent to the laboratory, the
physician recognizes a CBC was done
earlier that day when the patient was in
the local emergency room and does not
want to duplicate the testing
Provider staff can send a cancel request to
the laboratory, but cannot cancel the order
in the EHR. Laboratory staff will determine
per the laboratory’s policy on whether the
test and associated charges can be
cancelled at this point.
Scenario continued: After the specimen
has been sent to the laboratory, the
physician recognizes a CBC was done
earlier that day when the patient was in
the local emergency room and does not
want to duplicate the testing
Provider staff can send a cancel request to
the laboratory, but cannot cancel the order
in the EHR. Laboratory staff will determine
per the laboratory’s policy on whether the
test and associated charges can be
cancelled at this point.
Scenario continued: After the specimen
has been sent to the laboratory, the
physician recognizes a CBC with diff was
done earlier that day when the patient was
in the local emergency room and does not
want to duplicate the testing
Provider staff can send a cancel request to
the laboratory, but cannot cancel the order
in the EHR. Laboratory staff will determine
per the laboratory’s policy on whether the
test and associated charges can be
cancelled at this point.
Scenario continued: Testing personnel in
the laboratory recognize the specimen
was collected in the wrong tube and
reject it after the sample status is
updated to receive in the LIS.
Laboratory staff can cancel the order in
the LIS, which in turn cancels the order in
the EHR. The physician is notified of the
cancellation, the reason, and of any
guidance the laboratory may provide.
Scenario continued: During testing,
testing personnel in the laboratory
recognize the specimen is clotted.
Laboratory staff can cancel the order in
the LIS, which in turn cancels the order in
the EHR. The physician is notified of the
cancellation, the reason, and of any
guidance the laboratory may provide.
Scenario continued: After the hemogram
portion of the CBC is reported in the LIS
and testing personnel reads the manual
differential, testing personnel recognize
the specimen is clotted.
Laboratory staff can cancel the order in
the LIS, which in turn cancels the order in
the EHR. The physician is notified of the
cancellation, the reason, and of any
guidance the laboratory may provide.
6
Test report transmitted to
provider EHR
Scenario: Pediatrician orders a CBC on a
3 year old boy. The blood specimen was
collected (by either the provider or the
laboratory), received at the laboratory,
and testing initiated.
Scenario continued: After the specimen
has been sent to the laboratory, the
physician recognizes the CBC was sent to a
laboratory not covered by the patient’s
insurance. The physician asks if the lab can
cancel the test and send the blood
specimen to the correct laboratory.
Provider staff can send a cancel request to
the laboratory, but cannot cancel the order
in the EHR. Laboratory staff will determine
per the laboratory’s policy on whether the
test and associated charges can be
cancelled at this point.
Scenario continued: Testing personnel in
the laboratory recognize the results of
testing were not correct due to a
processing identification error.
Laboratory staff can cancel the order in
the LIS, which in turn cancels the order in
the EHR. The physician is notified of the
cancellation, the reason, and of any
guidance the laboratory may provide.