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Update from FHIR Clinical Order Workflow call

• Merging FOE calls into COW =>COW-FOE
  • No objections to merging calls; and we will carve out US specific discussions when necessary; need to cancel Monday FOE calls
  • Outstanding task is to finalize IG for review - Next Ballot in January 2024 (no objections)
• Reviewed updates from BPM+ activities
• Discussed DeviceAssociation assessment
• Reviewed JIRA tickets 

Meeting Notes

• See Craig's v2 micro question: https://confluence.hl7.org/pages/viewpage.action?pageId=161080303#id-20230518Main-Subject:"v2discretemicroquestion"-Listservemessage(fromCraig)
  • Need to clarify the next steps/guidance.  Hans Buitendijk to ask Craig for suggestion and next Friday date to join.
  • Considering whether to use a similar approach to susceptibilities and use OBX-30 Observation Sub-Type.
  • Craig Newman to create an example that uses MIRM or perhaps a new value to then review whether it would cause problems or is fine.
  • Aiming for June 30 but at latest July 7

• Panel Discussion
  • Considering a connectathon on the variations possible.
  • Need not only simple examples, but the multi-level panels where nodes could either end up in DiagnosticReport (the one ordered) or the Observation (part of the actual results using hasMember to link).
  • We need interest/commitment next week or no later than the week after.
  • The scope does not have to be final, nor do we need to have the full complement of examples.
• Device Association - Lab-related Resources to review impact of change to Device/DeviceAssociation (notes will be moved to confluence page):
  • BodyStructure
    • Does not need to change distanceFromLandmark.device from reference(Device) to reference(DeviceAssocation)
    • While BodyStructure and DeviceAssociation have references to each other, the deviceAssociation only generally points to a Device being present, the BodyStructure indicates a relative position to a specific device.
    • BodyStructure already knows the patient and in combination with BodyStructure.device one can get to the DeviceAssociation if necessary.
    • As the DeviceAssociation can lead to multiple devices, where the patient is already clear (BodyStructure.patient is 1..1) one can go directly to BodyStructure.device(Device).
    • No change needed.
  • Observation
    • Need to discuss this plus Specimen before we can finalize conclusions on DiagnosticReport
  • Specimen
    • Need to discuss this plus Observation before we can finalize conclusions on DiagnosticReport
  • DiagnosticReport
    • Need clarity on an example where a test is performed on a device (e.g., scalpel, EKG lead) to test for contamination/growth, etc. using Observation and Specimen.  Would that indicate that the DiagnosticReport.subject would be patient or device?  Possibly device as such a test is about the device, although it would give insight into how it impacts the patient (e.g., the source of their infection is likely that device or not).  The association between the device being tested and the patient that it is relevant to is likely going to be established through the actual Observation and/or Specimen.  But it is not yet clear how.
    • Need to go through Observation and Specimen first to then understand whether DeviceAssociation would need to be included in DiagnosticReport as a choice, or whether Observation and Specimen are enough.  
    • Will come back to this one then.
  • DocumentReference
• See May WGM carry-over FHIR JIRA Tickets below

V2 Lab JIRAs (link)

The following JIRA Tickets need to be reviewed by the Lab members as carry over from May 2023 WGM:

• V2-25376
  • Daniel Rutz see WGM Notes

FHIR Lab JIRA (link)

The following JIRA Tickets need to be reviewed by the Lab members as carry over from May 2023 WGM:

• FHIR-32406
• FHIR-32405
• FHIR-33041
• FHIR-34205

Next Meeting: June 9, 2023

Chat History

Andrea Pitkus to Everyone (Jun 23, 2023, 1:18 PM)
agree having sub order (messaged as OBR) and result (OBX ) pairs for each add on order panel/individual underneath that parent Order is the right structure.  Also agree having the linkage up to the pair order and parent specimen is good practice (since the isolate is a derived specimen).  Isolate may be sent as specimen with an AST order too to PH and then returned to the hospital lab like any reference lab result to report all back to provider.
You to Everyone (Jun 23, 2023, 1:20 PM)
http://www.hl7.eu/refactored/tab0937.html
Andrea Pitkus to Everyone (Jun 23, 2023, 1:38 PM)
Here are the examples to begin with  https://build.fhir.org/ig/HL7/fhir-order-catalog/exlabservices.html
http://build.fhir.org/ig/HL7/US-Core/DiagnosticReport-cbc.html
I think the description of observations without results pertains to the point I made where panel orders (e.g. CBC, BMP) are desired by Hans and others to be represented as observations in DR to group the result observations therein.  I'd prefer to have these as Service request orders, but that is what we have to discuss.  what is used to represent the CBC item?  I think we agree all results would be observations.

Andrea Pitkus to Everyone (Jun 23, 2023, 1:44 PM)
The other aspects is querying.  HOw does Hans and others get all the CBC items in a single query?  Do they query the node observation as he indicated or the CBC service request from my perspective?  Depending on what we decide is the "grouping" item.

Andrea Pitkus to Everyone (Jun 23, 2023, 2:00 PM)
DR is about the patient
but the specimen cultured would reflect the device/physical object