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Meeting Details

Date:  April 14, 2023

Time: 10AM ET

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


Gelu Comanescu (CDC), John King (Flexion), Michael Lingenfelder (CDC), Scott Fradkin (Flexion), Kathy Walsh (Labcorp), Peter Muir, Kayla Perkins (CDC), Marti Velezis (Donrisa / FDA), Ralf Herzog (Roche), JD Nolen (Mery Children's Hospital), Riki Merrick (Vernetzt / APHL)

Chair: JD Nolen

Scribe: Riki Merrick

  • Quorum Met 


Meeting Resources

PSS: PSS-2101

IG Proposal: Clinical Order Workflow (COW)

JIRA Tickets: OO Workflow JIRAs

Background Materials


  • Work through the Order Catalog IG Example 1 
    • Blood potassium test example:

      • Single order = ServiceRequest

        • Implicit split creates more sublevel ServiceRequest resources

          • ServiceRequest for specimen draw for phlebotomist (Person based resource):

            • OPTION 1 – this may be implicit when done at the provider’s organization

            • OPTION 2 – this may be implicit when done at the lab’s organization

            • OPTION 3 - explicit for draw via intermediary

              • 3A at a collection center

              • 3B drawn at a home

            • ALL will:

              • Create a task

              • Create a specimen resource

              • Then close this sublevel ServiceRequest and task

          • ServiceRequest for lab

            • Creates a task

        • OPTION 1 = done at the provider’s organization

          • Top level ServiceRequest

            • Task at provider for specimen collection

          • Top level task is  sent to the lab along with the specimen and task

          • Provider knows

            • status of specimen collection (internal task is closed)

            • status of order (status on task until status on ServiceRequest is closed and result received)

      • How to handle error correction and order modifications? Later

      • How to handle unsatisfactory specimen – for example hemolyzed sample, or unspun sample?

        • If the provider collected would have to cancel and request re-draw from the lab

      • What if the order is a panel?

        • Could mean multiple different specimen – would that require a separate ServiceRequest / task?

          • Only if that is done at different times (and potentially also different people) – for example multiple blood sample and random urine, but if urine is 24 hour or if special procedure like biopsy / CSF

      • Seems that task is dependent on company policy (if you have 1 person responsible for all collection, then no need for multiple tasks, but could make task/specimen) also depending on how billing is set up, may need to include ServiceRequest, if that is what you need in order to bill

      • Sharing the status?

        • is via the task – it is the placer’s responsibility to update the status in their own ServiceRequest based on the businessStatus value returned in the task

          • Service Request for the top level is the summary of ALL sub-ordinate ServiceRequest.status values

          • Does that mean the vocabulary for task.businessStatus needs to change based on the domain we are in?

            • Yes, create a profile for each of the domains we are using so we can adjust the vocabulary – that should also work when translating that into the inside lab workflow

            • Do we need to create the minimum set of status concepts need to be included (not the words used, but the concept expressed – like completed – could be collected / dispensed / completed

            • Could we use table for order status as a starting point for lab = HL70038 =

              • may want to create “buckets” of:

                • in progress (scheduled, some, but not all results, specimen received (that is in a different table – result status HL70125)

                • resolved with the different permutations (canceled, completed, replaced)

                • Exceptions? (on hold, error?)

    • Powerpoint Version 9 uploaded. It is >here
    • Pick back up here next week
  • Logistics:
    • Will have the catalog call to discuss Francois’s email and determine where we are with ballot reconciliation and decide on next steps

Adjourned 11:01 AM EDT


  • Peter Muir 10:15 AM
    • Should scenario overview consider lab test ordered as part of panel from parent?
  • Riki Merrick 10:22 AM
    • we are trying to start with the easiest first
  • Peter Muir 10:31 AM
    • Panel could simplify with items referencing single task vs repeating same info multiple times
    • One component of lab panel could have timing requirements (eg fasting glucose) that would affect panel timing. Example of blood draw and u/a could be one task with two components since 2 different actions required or nurse and lab tech.