Hans Buitendijk (Oracle), JD Nolen (Mercy Children’s Hospital), Riki Merrick (Vernetzt, LLC / APHL), Freida Hall (Quest Diagnostics), Nancy Spector (AMA),  Sheryl Taylor (NIST), Marti Velezis (Sonrisa / FDA), Ralf Herzog (Roche), Andrea Pitkus (UW), Rob Hausam (Hausam Consulting), Kathy Walsh (Labcorp), Dan Rutz (Epic), Jorge Lopez, Ana Szarfman (FDA), Ed Heierman (IICC / Abbott), Christina Gallegos (APHL), Lorraine Constable (Constable Consulting)

Chair:  Hans Buitendijk

Scribe: Hans Buitendijk, Riki Merrick

Quorum Met = Yes

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  • Continuous glucose measurement
    • Ana raised an interest to address.  Marti will connect as there is work in flight in another workstream.
  • eSignature Update: The following CMS rule has been released: Title: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard; Scheduled Pub. Date: 12/21/2022; Permalink:  Response 12/21 + 90
    • it does include commerce law language allowing a symbol as substitute as described to us by John Moehrke
    • ACLA had a call with ONC representative to remind them that we still have to resolve this – it will affect ALL existing interfaces in the orders and the results
    • Hans to give PAC a heads up that OO will provide feedback on this
    • Add to agenda at WGM or first call after WGM...  If during the WGM, will reach out to Freida to join.
  • Update from FHIR Lab Workflow call (2022-12-16 Order Logical Model Application to FHIR)
    • Reviewed current status
    • Rob & Jose to move the IG over to HL7 repo
    • Jose will not be at WGM, but we have Mon Q2 and dial in for Ralf and Jose
    • Discussed jira around task
      • Resulted in need for adding a glossary for this IG to have definitions
    • Not meeting next week
  • LIVD
    • Review tabs;
      • Bundle
        • Template is aligned with Hans and all elements are mapped = completed
      • Composition
        • Template is aligned with Hans and all elements are mapped
        • Need to make sure mapping guidance describes that version of concept map sits here
        • You have to check all included testcode concept maps and check to see, which of the LOINC concept versions the LOINC used for the mapping is in – any LOINC should only be in one of the LOINC conceptMaps we include in the publications
        • Shouldn’t we include the LOINC version at the testConceptMap resource to make this specific
          • Looking at the R4 conceptMap:
          • Would you use the version specific URI under target URI?
            • Not expected to have that done – expectation is to map to
          • In result conceptMap we allow mapping to multiple target code systems, but they should point to different codeSystems in different conceptMaps (Although LOINC Answer codes can be listed here, US LISs don't have functionality to implement as SCT is the standard in regs/cert, etc.)
          • Target and MUST be the same if we add version ONLY on one of them – if we do that, then why have both
            • How often will we have multiple groups? – often, so then put it in group ONLY
            • When combining multiple manufacturers, we would have different concept maps, so group.version will also work
          • If we use the in, then we can find out the code system version that way, because it is in there
          • So should we remove just
            • That will allow us to have a single conceptMap with multiple code system mapping?
            • If we keep ConceptMap.targetUri and point to the targetUri code system, then we have to provide guidance that MUST pull from the same code system identified in conceptMap.targetURI (using [name]CodeSystem.url = targetUri
  • No call next 2 weeks

Call adjourned 

  • ISA = LOINC/SNOMED/CPT PLA - will discuss on first call after WGM = 1/27/2023 
    • Proposal being prepped by: Nancy Spector, Ana Szarfarm, Kathy Walsh, Andrea Pitkus, Hans Buitendijk, Dan Rutz
    • OO Lab and CPT PLA
      • PLA = Proprietary Laboratory Analyses
      • It is not messaged between healthcare organization
      • Nancy will ask AMA to review this content
      • Discuss should this be on this webpage?
        • Any data that is associated with a patient outside of internal analytics in a specific system that will be exchanged
        • Laboratories that have inventory / catalog and submit this to CMS, so this has applicability to interoperability – so yes, we agree it should be in the ISA
        • May need to evaluate if this is in the right use case
          • One health system uses the PLA codes internally for ordering of lab
          • We may need to make clear that LOINC is the primary code and that PLA codes can be used similar to local codes – this could be done in the LOI guide?
            • No, we don’t want to have everyone’s option explained in the LOI – this would be explaining how NOT to use PLA codes …
      • Next Steps:
        • Describe the proper use of these codes, which is categorizing the type of order available on the lab system, not to order a test on a patient sample – Nancy to verify with AMA and possibly write clear user guidance on how these codes are intended to be used
        • Once we have that, then decide if we request for ONC to create a separate use case page for sharing this vocabulary
      • This is expecting that PAMA legislation (with cuts for labs) will be passing