Please help me understand this difference with examples in detail
Good question,
The short answer is a single orderable and resultable test such as Potassium or Hemoglobin are considered Order/Observation=Both as they are mapped to the Order and/or the Result in data dictionaries often with the same term. A Complete Blood Count (CBC) order panel is an order only as there are no units, result values associated with it, but the Hemoglobin (which would be mapped to the Hemoglobin Ord/Obs LOINC), Hematocrit and other results in the panel have numeric result values. There are some results that are not ordered but a result of panel orders such as a calcium/creatinine ratio (the calcium result value and creatinine result value in this panel are used to calculate the ratio). Thus the ratio is a result only and would be mapped to an Observation only LOINC.
Let us know if this addresses your questions.
Thank you Andrea!
I understood what an “order” and what “both” signifies but I could not get why “observations’ exist alone, isn’t all observations are ordered? Ideally all observations should be - “both” ?
Please help me out by clarifying with an example.
There are a variety of operational definitions for orders and observations so I understand your question.
For example, the laboratory medicine and pathology community do not refer to laboratory test orders and laboratory test results as observations. They are referred to as orders and results. In US CLIA regulation, they are referred to as the “test to be performed” (order) and the “test performed.” (result)
There is even agreement amongst standards folks as to what is an “order” or what is an “observation?”
Some of us refer to the order as the order test name which is built in EHR and LIS data dictionaries and mapped to LOINC (e.g the CBC example). While in other cases, it’s the order test name, + the patient details + the medical legal provider and all the information required in an order requisition (aka the order).
For exchanges, HL7 version 2 refers to OBX as Observation Result and OBR they call Observation Request (the word they used for orders). In FHIR, Service Request is the name of the FHIR Resource used for orders. While results are communicated as FHIR Observations usually more than one in a FHIR Diagnostic Report. There are those who wish to use Observation based upon Service Request to group all the results in an order panel (examples in order LOINC codes), while others want to use FHIR Observation for the CBC test order name when used in a Diagnostic Report. This later use creates a LOINC mapping issue as an Order only LOINC is used in FHIR Observation.
There may be other examples, but I think you can see the challenges.