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Meeting Details

Date: April 21, 2023

Time: 10AM ET

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

Attendees: Rob Hausam (Hausam Consulting), Ralf Herzog (Roche), Riki Merrick (Vernetzt, LLC / APHL), John King (Flexion), Scott Fradkin (Flexion), Kathy Walsh (Labcorp), Kayla Perkins (CDC), Andrea Pitkus (UW), Marti Velezis (Sonrisa / FDA), Michael Lingenfelter (CDC), Bob Dieterle (Enable Care), Gelu Comansecu (CDC), Annie Raval (CDC), Dan Rutz (Epic), Thomas Zhou (AH)

Chair: Ralf Herzog

Scribe: Riki Merrick

  • Quorum (CH-Chair +2) Met 


  • Workflow Topics
  • JIRA Tickets 
  • AOB?

Meeting Resources

PSS: PSS-2101

IG Proposal: Clinical Order Workflow (COW)

JIRA Tickets: OO Workflow JIRAs

Background Materials


FHIR Workflow

  • Working on slides - specifically the different ways / places specimen can be collected and how that might affect workflow
    • If specimen collection is performed at different locations, you may need to create a subordinate-service Request to split up the “requisition” – to be able to provide more detail / authorization in the task
      • No linkage from parent request to child orders in the resource (might be implicit only by how this is set up in the CPOE), since at the time it is created it will not know that it is going to have children, but the children “know” = basedOn its parent – to find all the children, have to look for all serviceRequests, where parent is referenced via this attribute
      • Would this also work for the recurring orders?
      • Need to figure out how the parent order “knows” when all child orders are fulfilled
      • Subordinate ServiceRequest = child orders are
    • How does requisition play in?
      • Is attribute in SerivceRequest, so all associated ServiceRequests can be found that way, too
      • Represents the medico-legal authorization, too
    • Is there consideration of intermediary that gets the task that has to decide who performs the actual task
      • Discharge planning offers multiple places to fulfill the specimen collection and subsequent testing – how to handle that?
      • Or when the testing is being referred – this needs a new ServiceRequest?
        • Created a Filler order in POA
        • In social determinants the intermediary creates their own serviceRequest
          • Unclear on how these 2 are different
            • Filler Service Request is not changing the type of order, while the intermediary is splitting the order into multiple steps = breaking out this
        • Provider – lab – one ServiceRequest cycle, if sent on, then new ServiceRequest to the referral lab creates second loop that needs to be closed before the first loop can be closed
          • This may involve manual re-order in the lab system in the middle
      • Adding the intermediary into the ppt
        • Copy in the intermediary is not needed, but the referral lab id creating their own order in their system = Filler Order – this should have the requisitionID
          • The subordinate ServiceRequest may have different name for the test ordered and local code (and maybe even different LOINC) – it is not an exact copy
  • Slides at end of meeting: <Updated Slides, version 11>

Adjourned 11:01 AM EDT