Meeting Details

Time: 1 - 2PM ET

Coordinates:


Chair: JD Nolen

Scribe: Riki Merrick

Quorum Met = Yes


Attendees

Name 

Affiliation

Ralf HerzogRoche
Rob HausamHausam Consulting
JD NolenMercy Children's Hospital
Riki MerrickVernetzt, LLC / APHL
Yanick GaudetGlobal Star
Sarah GauntLantana
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Freida HallQuest Diagnostics
Dan RutzEpic
Nancy SpectorAMA
Olga VovkSamvit Solutions
Kathy WalshLabcorp
Lorraine ConstableConstable Consulting
Elliot SilverResMed


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Agenda:

  • Administrivia
    • Approve Minutes
    • OO Calls Next 7 Days (check if happening)
      • Specimen
      • HCP
      • OO on FHIR
      • Nutrition  - Suspended until new lead as Becky Gradl is moving on to other responsibilities that may still involve HL7, not necessarily Nutrition.
      • Main Call
      • Order Workflow in FHIR
      • Catalog - Suspended through end of year.  Check with Jose Costa-Teixeira  when he wants to pick this up.
      • LAB
      • Cancer Pathology Reporting
      • v2-to-FHIR
      • IHE SDC/eCC on FHIR 
      • DME - re-starting with expanded scope
      • At-Home Test Reporting on FHIR
      • Click to add a new task...
      • Upcoming deadlines:
      • Click to add a new task...
      • Click to add a new task...
    • Jan 2023 WGM
      • OO WGM 202301 - Attendance Log
      • OO WGM 202301 - Agenda
        • Co-Chairs to add availability
        • Negation – find different quarter with PC (not Wednesday)
        • Lab Order Conceptual Model Ballot recon – Tues Q3 – zoom for Kathy - will that work?
        • John Rhoads is looking to coordinate DEV topics – need to have more time for these topics, worst case will be Friday Q1
        • Patient Care negation discussion at WGM – Jay Lyle and Keith have differing ideas
          • Wednesday no Rob; Marti won’t be there until Tues late PM – aim for Thursday Q3 or Q4 (which coincides with FMG
    • Upcoming Deadlines
      • May 2023 Ballot:
        • NIB Deadline: February 19, 2023
      • Sep 2023 Ballot Cycle
        • PMO Deadline: February 5, 2023
        • TSC PSS Deadline: April 10, 2023
      • Jan 2024 Ballot Cycle
        • PMO Deadline: May 28, 2023
    • Expiring Specs:
      • HL7 Version 3 Standard: Common Product Model CMETs, Release 4 (Feb 2023) - in withdrawl ballot Jan 2023
      • no STUs in the next 6 months
    • Post Acute/DME
      • PSS was sent to TSC, no word yet
    • OO Project Proposal Triage
      • nothing new
    • Update confluence page to show Marti and Jose as full CO-chairs - Marti Velezis 
  • V2

    • eSignature

      • Related to Attachments/eSIG proposed rule topic, verifying if these have been vetted to validate if these 3 standards were balloted/published by X12: 006020X313, 06020X314, 06020X316.  These are listed on page 78452 of the Federal Register proposed rule – Marti will check
      • Meet authentication – currently only suggesting CDA eSignature as means for eSignature, but there is ambiguous
      • 2-year compliance date
      • This does not solve our current problem
      • This seems to be a scope change of what is considered attachments
      • Let’s put this on the agenda for the Friday 1 PM lab call and provide updates on this call, when we have details worked out to provide the feedback to PAC
    • From INM V2-25403 - Discuss deprecation of + in SN.3
      • This is enforcing a switch in the datatype for the test where they have used SN before – while this is not for each instance, it still requires a system change – it is not backwards compatible
      • Example for SCT codes:  
      • Currently we see this reported mostly:
        • Fluorochrome stain result as string: 2+ acid fast bacilli seen
        • Ketones in urine strip result as string: 2+
      • Current Definition in the standard: "-" or "+" or "/" or ":"
        • + is somewhat different here from the other characters are
      • Just reading, + is how some manufacturer's recommend reporting dipsticks – maybe reach out to those manufacturers (Clinitech) – Check if they are reporting this as SN = ^^+ - JD will check, 
        • JD Update: We have a few instruments (like a Clnitek) that result with "+"'s, but they are with a number (like "+1"). In some cases we map those results inside the LIS (PathNet, Cerner) to a "+" but that is for display only. 
      • Dan thinks it is more likely this is sent as ST or TX
      • Deprecating gives folks 2 more releases to let us know that we will remove it at some point – earliest will be v2.9.1 or V2+
  • FHIR
    • At-Home Testing issues
      • FHIR-38207
        • Discussion that equipment is different device
        • May not apply to many, but some At-Home tests
        • Will have 2 devices in these cases
        • Motion to accept the proposed disposition – Marti Velezis, Riki Merrick, no further discussion, against: 0, abstain: 1, in favor: 13
      • FHIR-38203
        • Propose to add in the reporting to PHR and EMR within smart app – if Dan has solution, we could add it, so mark for future use, as we need to figure out how to do this (contract runs out by end of February)
        • This has real world implications when patients cannot get the results into provider EMR so that appropriate care could be provided in a timely manner – only current way this can be done today, is for patient to contact provider via their patient portal application (we could maybe mention this as a example on how to do this outside of this IG scope)
        • We will add it to what we want to do in the future, similar to how we are considering dealing with prescribed tests that the patient can do at home
        • Motion to accept the proposed disposition – Sarah, Dan, further discussion: mark as considered for future use – this has not vote attached, because Dan abstained, but still put this comment on, so we can use it, else we would call this persuasive with mod, against: 0, abstain: 1, in favor: 13
      • Motion to approve the project team to complete the ballot reconciliation and upload the spreadsheet and request removal of negatives – Lorraine Constable, Riki Merrick, no further discussion, against:0, abstain: 0, in favor: 14
        • Sarah Gaunt to send spreadsheet to co-chairs for upload, when compiled
    • SDC FHIR Ballot Tracker
      • FHIR-38066 - Clarify use of Terminology TRIAGED - NOT DISCUSSED - Alex Goel - no timeslot for WGM, need to check with Alex, think he is not attending

Call adjourned 2:00 PM ET - BELOW NOT DISCUSSED

    • FHIR-37964 = AOE implementation in ServiceRequest
      • Proposed Motion to convert ServiceRequest.supportingInfo
        • to backbone for supportingInfo similar to DiagnosticReport, but with type attribute as 0..1, example binding to V2 Observation type
        • reference to any
        • discussion: will need to update to newer version of IG will have to review the updates to the underlying standard and how that will work
        • separate attribute (to be able to match 1:1 to DataInputObservationDefinition in catalog) or supportingInfo - discussion from Friday's calls (2022-08-19 Order Logical Model Application to FHIR and 2022-08-19 Lab)
          1. Option 1: Use the same structure but add an invariant to restrict the reference to Observation if type equals AOE and make the same invariant for supportingInfo in DiagnosticReport with an alias for AOE
          2. Option 2: Make another structure that only for AOEs (InputObservationResponse) with an alias for AOE and also add a similar structure to DiagnosticReport
        • Zullip chat https://chat.fhir.org/#narrow/stream/179256-Orders-and-Observation-WG/topic/AOEs.20in.20ServiceRequest.20and.20DiagnosticReport - so far no answers
        • Also to be included in the discussion - supportingInfo in DiagnosticReport FHIR-36858 - Provide a mechanism to reference "prior studies" WAITING FOR INPUT
        • Some examples of AOEs:
          • Examples Last Menstrual period
          • Urine volume and duration of collection, etc. when used in the calculation of results being reported
          • Specimen source
            • Often included as AOE in the panel (may be important to have the clinical information) – but that does not need to be represented in the data exchange paradigm
            • How does this work with CLIA requirements – might restructure LIS
            • We need to support regulatory behavior in the standard to support the regulatory requirements, but not define the regulation
        • Out of the 3 options listed:
          • Hans did not like to add a new element specific for AOEs
        • We can currently do this with existing structure, but we would like to have a better way to provide guidance how specifically handle AOEs
          • If we use observation as the reference from supportingInfo – then we can still have “free text” in observation.value, but do we need to make an invariant for this to allow only observation as reference – could potentially also have questionnaire and questionarieResponse
      • FHIR-19362 -  Incorrect reference direction Procedure -> DiagnosticReport
          • FROM OO on FHIR call on November 8, 2022 added the disposition "Persuasive with Modification"
            • OO will add .partOf to DiagnosticReport and DocumentReference, per the Event pattern. 
            • OO will ask Structured Documents WG to also add .partOf to Composition, per the Event pattern.
            • OO will ask Patient Care WG to consider removing the Procedure.report 0..*    Reference(DiagnosticReport | DocumentReference | Composition) in light of the changes to the referenced resources
          • FROM Main call December 1, 2022: 
            • If change is made to Diagnostic Report – the other changes (to resources not owned by OO) would need to be changed
            • The change would be better now while Resources are not normative
            • IGs are affected (e.g., US Core - and specifically US Core Lab results)
            • Procedure.report changes to 
          • Update from WORKFLOW call December2:
            • NEED TO ADD!!!!
    • Projects/Feedback: (Updates in BOLD)




1 Comment

  1. Alex Goel

    Ulrike Merrick I do plan on being at the WGM FHIR-38066 has a proposed resolution and needs quick discussion and a vote. It was already discussed.