Meeting Details

Date:

Time: 1 - 2PM ET

Coordinates:


Chair: Hans Buitendijk

Scribe: Hans Buitendijk/Riki Merrick

Quorum Met = Yes


Attendees

Name 

Affiliation

Hans BuitendijkOracle
Riki MerrickVernetzt, LLC / APHL
JD NolenMercy Children's Hospital
Rob HausamHausam Consulting
Alex GoelLantana
Kathy WalshLabcorp
Dan RutzEpic
Ralf HerzogRoche
Yanick GaudetGlobal Star
Marti VelezisSonrisa / FDA
Freida HallQuest Diagnostics
Elliot SilverResMed
Sandy JonesCDC
Andrea PitkusUW




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Agenda:

  • Administrivia
    • Approve Minutes
      • 2022-12-22 Main - Motion to accept as published.  JD Nolen, Yanick Gaudet
        • Against: 0; Abstain: 1; In Favor: 12
      • 2023-1-05 Main - Motion to accept as published.  JD Nolen, Yanick Gaudet
        • Against: 0; Abstain: 1; In Favor: 13
    • 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
      •  
    • Jan 2023 WGM
      • OO WGM Attendance Log - 202301
        • remove the Attend WGM as an option for next time
      • OO WGM 202301 - Agenda
        • Co-Chairs to add availability
        • Patient Care negation discussion at WGM – Jay Lyle and Keith have differing idea
          • 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 withdrawal ballot Jan 2023
        • Passed the ballot
      • no STUs in the next 6 months
    • Post Acute/DME
      • PSS was sent to TSC, no word yet.  Riki to check where it is in the TSC queue
    • OO Project Proposal Triage
      • PSS-2145 - Getting issue details... STATUS - Motion to have no comment.  Riki Merrick, Elliot Silver.
        • Against: 0; Abstain: 1; In Favor: 12
  • V2

    • eSignature

      • During WGM (make sure to let Freida know, if we get to it) or after to dive in.
    • NOT DISCUSSED: 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
    • R5 Deadline
      • Feb 24 is the freeze for R5.
    • SDC FHIR Ballot Tracker
      • FHIR-38066 - Clarify use of Terminology TRIAGED
        • Persuasive with mod
        • Add description on this page; https://build.fhir.org/ig/HL7/ihe-sdc-ecc-on-fhir/terminology.html how to apply mappings from CKeys to the standard codes and refer to Standard codes- update sentence to the
        • Does this support one-many mappings- yes based on FHIR rules that you need to have many conceptMaps
        • See JIRA for resolution in more detail.
    • NOT DISCUSSED as homework still outstanding 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
    • NOT DISCUSSED 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!!!!
    • What was the result between the DiagnosticReport vs Composition discussion
      • What references are expected / allowed – did that get resolved?
        • Primary reference is from DiagnosticReport to composition so that the content can be organized in a specific way, but allow the other way
        • When a DiagnosticReport is included in a discharge summary, should point to the DiagnosticReport (which has the link to the composition for display / sorting of components) from the proper section of the overall document– potentially could point to the composition also
        • X eHealth was using an extension to allow the reference  Robert Hausam to please update this statement 
    • FHIR-38818 - Supply Delivery
      • Profiled this in IHE as extension - would like to add this back into the core
      • To be discussed at WGM Tues Q2.

Call adjourned 2:01 PM ET

  • Projects/Feedback: (Updates in BOLD)