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Meeting Details

Date:  June 2, 2023

Time: 10AM ET

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

Attendees: Ralf Herzog, JD Nolen, Andrea Pitkus, Rob Hausam, Kathy Walsh, R. Michael Lingenfelter (BAH/CDC), Bob Dieterle (EnableCare), Annie Raval, Dan Rutz, Scott Fradkin, Brian Handspicker, John King, Riki Merrick, Marti Velezis

Chair: Ralf Herzog

Scribe: Marti Velezis

  • Quorum Met 


Meeting Resources

PSS: PSS-2101

IG Proposal: Clinical Order Workflow (COW)

JIRA Tickets: OO Workflow JIRAs

JIRA Grouping Tag:

  • OO-COW - to indicate when the JIRA Ticket should be reviewed by the OO Clinical Order Workflow SMEs, especially when the issue is not assigned to the Resource owner.

Background Materials


  • OO ONC NPRM Response Draft

    • Action for today: Need to finalize comments and send them to HL7 PAC
    • Discussed the comments
      • RE: The utility and maturity of existing HL7 v2 and C-CDA standards supporting laboratory interoperability and the impact of moving to FHIR-based laboratory data exchange.
        • In the summary statement – Riki had a comment to reword as the workflow is not completely covered in FHIR US Core
        • Riki Merrick to Everyone (Jun 1, 2023, 1:35 PM)
          • FHIR US Core examples are not mature enough to handle lab results
          • FHIR and CDA are not implemented in the lab space
          • CDA is used for data sharing between providers
          • FHIR US Core is not mature enough to consider in certification
        • Andrea Pitkus to Everyone (Jun 1, 2023, 1:37 PM)
          • While FHIR elements needed for laboratory orders and reporting are generally available, profiles, implementation guides, US Core, and other needs to implement and support laboratory data exchange in accord with CLIA are not yet mature.
        • See comments on the confluence page
        • Will discuss and finalize today
    • Updated 6/2 - The Confluence page was updated with the revisions
  • IG proposal:
    • Updates made to the Clinical Order Workflow (COW) IG Proposal which is still in the "pending' state.
    • Action item from 4/28: Please review the IG proposal and make any comments on the proposal with any related IGs and/or additional use cases
      • No comments added to that meeting page with suggestions
      • Need to determine when the IG proposal will be submitted
      • Leave the ? after Immunization / medication – take out pharmacy related references
      • Does inventory fit into “clinical” order?, though the same principal should also apply to inventory, but those are not clinical
      • Add BPM+ to involved parties
      • Add SDOH Clinical Care IG and Gravity project code extensions as content source
      • Examples:
        • Ordering DME post hospitalization
        • Ordering medically appropriate home delivered-meals post hospitalization
      • Next steps:
        • Review and bring back next week
    • 6/2 - Today's Notes
      • Revised the IG proposal baed on review of the content
      • Key changes: 
        • Updated maintenance plan
        • Updated Log Description:
          • Need to add medications associated with device (e.g., infusion pumps) or as an essential part of a treatment plan (e.g., oncology therapy) in coordination with the Pharmacy working group
          • Administration of of Biologically Derived products (e.g., blood transfusions) 
        • We will vote on this next week – working group should review the updates.

Next meeting: June 9, 2023

---------------Adjourned at 11:03PM EDT-------------

Not discussed: 

JIRA Backlog (time permitting)

Chat history

Dan Rutz to Everyone (Jun 2, 2023, 10:51 AM)
Also I am not confident that FHIR can support high quality pathology, imaging, and genomic resulting because those have not been exercised to my knowledge.  Until we cover those and ensure those needs can be met, I don't think we can feel FHIR is ready to result as a primary workflow.
Annie Raval to Everyone (Jun 2, 2023, 10:52 AM)
During yesterday's USCDI+ call, there was discussion about a subgroup dedicated to data elements for Lab data exchange. I am curious if there are plans to address any missing data elements related to CLIA compliance during their efforts. Does anyone have information on this?
Andrea Pitkus to Everyone (Jun 2, 2023, 10:53 AM)
we have many of the elements for lab data, but we need the implementation guides such as lab orders being discussed on this COW lab call.
LIS vendors will need for some lab areas wil need to do major development to be able to have discrete elements in the lab order and result dictionaries, support encoding and then FHIR modeling

Annie Raval to Everyone (Jun 2, 2023, 10:57 AM)

Thank you for the clarification.

Andrea Pitkus to Everyone (Jun 2, 2023, 10:58 AM)

Rob Hausam to Everyone (Jun 2, 2023, 10:59 AM)
Suggestion: “… needs further development and testing in order to be sufficiently mature”

Andrea Pitkus to Everyone (Jun 2, 2023, 11:00 AM)
Also for anything in blood bank there are FDA requirements for LIS