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OO Main - Meeting Information

Meeting Details

Date:  May 18, 2023

Time: 1 - 2PM ET


Meeting Status

Chair:  JD Nolen

Scribe: Marti Velezis

  • Quorum (Co-Chair + 4) Met 

OO Events 


OO Calls Next 7 Days (check if happening)

  • Clinical Order Workflow in FHIR
  • Catalog
  • LAB
  • FHIR Orders Exchange (DME/Acute/Admin)
  • v2-to-FHIR
  • Specimen
  • HCP
  • OO on FHIR
  • Cancer Pathology Reporting
  • IHE SDC/eCC on FHIR 
  • Nutrition
  • v2-to-FHIR (on hiatus for now) 
  • Main Call
  • LIVD

Upcoming Topics/Due Dates



May 28, 2023January 2024 Ballot - PMO Deadline


(Names of people present are BOLDED)



Ralf HerzogRoche
JD Nolen
Rob HausamHausam Consulting
Hans BuitendijkOracle
Riki MerrickVernetzt, LLC / APHL
Yanick GaudetGlobal Star
Sarah GauntLantana
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Jackie Hemenway
Dan RutzEpic
Jose Costa Teixeira
Olga Volk
Bob DieterleEnable Care
Kathy WalshLabcorp
Lorraine ConstableConstable Consulting
Elliot Silver
Craig Newman
Donna Pertel
Christopher Harrison

Agenda and Notes:


Approve Minutes

  • Need to finalize WGM Meeting Minutes

  • Next time add any outstanding MM approval

Key Topics for today: 

  • Administrivia
    • PSS Reviews
  • WGM Updates
  • Micro question from Craig
  • Block Vote next week

OO Project Proposal Triage

  • PSS-2206 - Getting issue details... STATUS

    • Would like to track the interaction around the ServiceRequest and Care Plan and related lab order workflow for testing
    • Interested Party, we do not want to lead this topic
    • Added a comment in the PSS
  • PSS-2205 - Getting issue details... STATUS
    • Project proposal to explore creating profile(s) on relevant resource(s) (e.g., Observation) and potentially an IG if the profiles are not considered "core" content.
    • FMG suggested that the description be updated to ask for help with this effort from other working groups  
    • Updated the description with additional details

Other (Project Approvals, NIBs, etc.)

  • May 28, 2023 - Deadline for new project proposals for January 2024
  • (Did not discuss) Expiration of standards:
    • HL7 Version 3 Standard: Clinical Statement Pattern, Release 1 - August 2024 - Re-affirmation or Withdrawal for May 2024 Ballot
  • (Did not discuss) ONC New Proposed Rule HTI-1 on Information blocking and increase USCDI to version 3
    • Laboratory RFI (LOI, LRI, FHIR COW/FOE, and could consider commenting on Catalog, LIVD efforts) - See pages 331 - 334

WGM Stuff 

  • Overview of the WGM
    • Reviewed the Meeting Minutes: 2023-05-08-12 WGM
    • Key points
      • R6 Planning 
        • For Comment Ballot - i.e., Interim Releases for snapshots of some additional information to be reviewed by the community
        • September 2023 - may be the first point release with changes to R5 - this is a review snapshot; planning for a total of 3 reviews
        • 2-3 years for updates to IGs with any changes for R6
      • BPM Health +
        • Lorraine sent them the PowerPoint with workflow 
        • BPM team will help model in their tools
        • Lorraine will participate in this discussion and bring back to the respective groups.
      • Need to finalize the meeting minutes before approving.
  • Need to follow-up on the following from WGM.    
    • FHIR-34207 - Add attribute to document confirmation TRIAGED 
      • Added a proposed disposition. Will circle back on this on a lab or main OO call
      • Did not discuss - shifted to Lab call on May 19th.  


  • Block Vote was sent out Wednesday, May 17, 2023 for review and will be voted on next time – May 25, 2023. 
    • Aged tickets
    • Deprecated issues
    • Any issues that were not substantiated by the reporter 
    • Let us know if you want to pull anything from the list.

Subject: "v2 discrete micro question" - Listserve message (from Craig): 

LRI discusses in gory detail how discrete microbiology is conveyed in a v2 message. This includes how to link susceptibilities to a given isolate found via the culture using OBR-26, OBR-29 and potentially OBR-50. But I have heard about a variant that I’ve not come across before that I wanted to ask about.

Has anyone encountered where tests other than susceptibilities are performed and reported on an isolate. For example, I’m seeing an example where a VanA PCR is performed on each isolate. Conceptually, this is similar to a susceptibility but I think most systems would rebel if we added a VanA PCR result as an OBX along side susceptibilities. But it’s hard to include them in the culture report ORC/OBR because they are isolate specific. You can link stuff via subID (so that an Isolate observation and the corresponding VanA observation have the same subID, but I’m not sure I’d trust all systems to display them together by creating a clear and unambiguous linkage). And I don’t think we want to create multiple observation codes for OBX-3 which incorporate the isolate (e.g. Isolate 1 VanA PCR, Isolate 2 VanA PCR).

Discussion Today: 

    • Also see ORD Listserv messages with discussion
    • Scenario: Local PH lab that uses an EHR to place order the lab →  State PH lab → Results sent back to Local PH lab 
      • Distinguishing the results between the test(s) ordered and what is completed
      • Results may be displayed as individual tests by EHR vendors
      • Currently EHR Vendors representation of Reflex testing may only support this for specific cases
      • Add final guidance (or note that no guidance or patterns are currently available).

----------Adjourned the meeting at 2:01PM EDT-----------------

E-Signature Update

  • Yes
  • No
  • Check back in June for progress


  • Yes
  • No

UP-44 -no value set content defined for v2 table 963 value set 

  • Leaving UP-44 open for now – so that the new tickets and this one can be linked

V2-Jira Review (time permitting) 

  • Yes
  • No

Projects/Feedback (Updates in BOLD)

  • Yes
  • No

Discussion Topics: 


  • Yes
  • No

Block Vote of old Jira trackers set for next main call - see:

JIRA StatusJIRA IDDiscussion/Disposition
JIRA Issue Backlog
  • Should the extension be removed?
    • 4/27 NOTES:
    • Side-bar: There are also several extensions on other resources, for example for nutrition that we are not sure where the extensions came from
    • Related Jira referenced in comments = FHIR-29273
      • This jira mentions these artifacts
        • Blood Pressure Panel
        • Body Length
        • Body Weight
        • Head Occipital-Frontal Circumference by Tape Measure
      •  came from Rita Pyle
    • A component is different from a qualifier
      • It is not in the definition for component, but mentioned in text in we say “or may provide qualifying information to observation.code”
        • Can we find out how this text got added? – It is in R4, but not R3, so maybe we can find it
      • Is the bodyposition an observation that is part of the bloodpressure measurement procedure?
        • Diastolic pressure
        • Systolic pressure
        • Body position – this would have to apply to both of those measurement
      • The old jira came from Rita Pyle – let’s ask her to supply the list of qualifiers that are modeled differently – add comment to this Jira tagging her
      • Add Overall comment? We see a difference between qualifiers and components of an observation – let’s do some more research first
  • Total FHIR = 248 Tickets in Submitted, Triaged, Waiting For Input

    • FHIRCore = 221
    • FHIRCast=1
    • FHIRPath=11
    • FHIR IGs = 8


  • Add the ability to reference QuestionnaireResponse from DiagnosticReport
  • Pulled from Block for further Discussion by Dan Rutz 
    • Needs "a better evaluation of real examples of which workflow, procedures, and data structure truly invoke a DiagnosticReport which involves an embedded QuestionnaireResponse as part of the .result element.  It may be valid, but needs to be well-substantiated."


  • At-home Test - Deferred tickets that have been reopened.
  • This group is not meeting – how or when do these tickets get resolved?

  • Grouping the tickets with Observation.category changes
  • Discussed at WGM – need to determine outstanding JIRAs

Catalog JIRAs
  • No updates.

JIRAs to Be Applied (FHIR Core)

JIRAs to Be Applied (IGs)

  • Status of tickets


Total To be Applied:
  • 41 FHIRCore
  • 115 IG related
JIRAS to be marked Published


Note - these are in the published R5 on