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Meeting Details

Date: March 3, 2023

Time: 10AM ET

Coordinates:  Join Zoom meeting: | Meeting ID: 510 046 7805 | +1 929-436-2866-US (New York)

Attendees: Ralf Herzog (Roche), Scott Fradkin (Flexion), Bob DIeterle (EnableCare), Victoria Derbyshire (FDA), Kayla Perkins (CDC), Michael Lingenfelder (CDC), Kathy Walsh (Labcorp), Annie Raval (BAH/CDC), Rob Hausam (HAusam Consulting), Gelu Comanescu (CDC), JD Nolen (Mercy Children's Hospital), Omar Khan (NHS England), Riki Merrick (Vernetzt, LLC / APHL, Andrea Pitkus (UW), Marti Velezis (Sonrisa / FDA), Ana Szarfman (FDA), Kimberly Labno (), Dan Rutz (Epic)

Chair: Ralf Herzog

Scribe: Riki Merrick

  • Quorum (Chair+2) Met 


Meeting Resources

PSS: PSS-2101

IG Proposal: Clinical Order Workflow (COW)

JIRA Tickets: OO Workflow JIRAs

Background Materials


  • Bob shared IG review with FMG
  • IG Proposal -Clinical Order Workflow (COW)
    • Revisiting the Grouping of Orders topic from last week:
      • Powerpoint shows these options:
        • Group
        • RequestOrchestration
          • (to support complex chemotherapy orders and other complex orders- so in the lab world this may only be needed if this orchestration is prescribed by the placer)
        • CarePlan
        • Requesition
        • The grouper task resource
      • For representing an order Set
      • Grouping of several doctor orders (for instrument use maybe) – do we need to have ServiceRequest here, or would that be grouping via tasks?
      • What about for pooling of samples?
      • What about grouping for specimen processing / testing?
    • Is ServiceRequest just for medicol-legal aspects, so should the filler side even create a serviceRequest?
      • Filler side does track what they get – they call it accession is defined by the receiving lab
        • Can be associated to the sample, or the panel or the requisition
    • Panels are also defined by the testing labs (and maybe also by some billing perspective), they can be on the same panel
    • Placer ServiceRequest exists in the FHIR server of the placer does the filler need to have a copy?
      • Filler MUST retain the businessidentifer of the placer in the ServiceRequest
      • In V2 we have choices for communicating when a order is not the right one – so maybe have to make changes?
      • For Lab task may be good enough, would ServiceRequest be needed in other settings?
        • Radiology
        • Services
      • It may depend on whether the order is across multiple systems vs the same system at the performing lab
      • EHR-s CPOE use their own order names – not the order names of the performing labs -is that a change?
      • Maybe we treat the lab as a black box
    • We do want to report out status updates (order received / order accepted / specimen received / testing started / some results available / final / corrected)?
      • Do we need to create a status resource to do this, since FHIR is essentially stateless
        • the <resource>.status attribute is for the resource instance, not necessarily for the thing the resource is about – similar to the business identifier vs the <resource>.id
      • In V2 ORC-1 is so important (and also the result statuses) and we always send snapshots (though we can also support dynamic updates)
      • If you have multiple statuses for one order how do you deal with the multiplicity – decide what needs to come up in a meaningful way and where does it need to go
      • Maybe create a pattern to help drive subscription?
      • Maybe create a backbone and subscribe to that?
      • Could we make the task on the filler side exposable?
      • Task has
        • focus as reference to the resource - in our case the ServiceRequest from the placer
        • businessStatus as codeable concept without a defined value set (which may be related
        • statusReason (codable reference) – free floating not clear if this is for the business status or the resource status
        • status (for the resource) – code
      • We may need profiles on
        • serviceRequest based on the use case
        • task based on the focus being referenced

Next meeting: March 10, 2023 


  • Andrea Pitkus 10:20 AM
  • Andrea Pitkus 10:27 AM
    • Example E5 involves two different specimens which would have different accession numbers. It begins with a single parent order
  • Riki Merrick 10:28 AM
    • I don't know if that is ALWAYS 2 different accession numbers for all labs?
  • Andrea Pitkus 10:28 AM
    • Have all the use cases in mind been listed out where order grouping is desired?
  • Riki Merrick 10:29 AM
    • I don't think we have them all listed
  • Andrea Pitkus 10:31 AM
    • IT might help delineate where the different "grouping" models may/may not work for the use cases.
    • Especially if IVD differences, PH differences vs reference lab, hospital lab, clinic lab, etc settings so all are implementable.
    • Assume medications would use FHIR Medication Request:
    • for medication orders that are grouped in an order set, say with lab orders
    • or radiology (such as imaging with contrast)
    • or the lab challenge testing (stimulant or depressant)
  • Andrea Pitkus 10:39 AM
  • Dan Rutz 10:45 AM
    • So worth noting, ORC-1 and ORC-16 are currently not possible to model in FHIR - right?
  • Andrea Pitkus 10:45 AM
    • Has that been addressed in the v2 to FHIR WG, Dan?
  • Dan Rutz 10:46 AM
    • I do not know, I haven't been closely involved in that project.
  • Andrea Pitkus 10:46 AM
    • Me neither ;)
  • Andrea Pitkus 10:49 AM
    • ORC-1 lists FHIR Service Request.status and intent.
    • ORC 16 lists FHIR ServiceRequest.extension-request-statusReason
  • Dan Rutz 10:50 AM
    • I don't think that's actually right.
  • Andrea Pitkus 10:50 AM
  • Andrea Pitkus 11:00 AM
    • Start fleshing out examples from order catalog lab?