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Administrivia

Approve Minutes

• 2023-07-13 Main - Motion to accept as published.  Kathy Walsh, Yanick Gaudet

  • Against: 0; Abstain: 6; In Favor: 8

Elections

• Co-chair elections
  • Currently in flight. 
  • All workgroup members (those on the ord@lists.hl7.org) can vote.
  • Please vote by July 31.
  • If you are a write in candidate, let us know so we can create awareness.
• TSC Representatives
  • OO needs to vote on 2 of three candidates. 
  • One of them is Riki Merrick (well known to many).  Lloyd McKenzie and Gora Data are the others.
  • We will finalize who to vote for next week and submit.

OO Project Proposal Triage - Not discussed

• PSS-2246 - Getting issue details... STATUS -HL7 Implementation Guide for CDA® Release 2: National Healthcare Safety Network (NHSN) Healthcare Associated Infection (HAI) Reports for Antimicrobial Use (AU) reporting from Long Term Care Facilities (HAI-AU-LTCF-CDA)

  • The only reason to be involved would be to review vocab for suggested data elements - Riki thInks we can pass on this one - but maybe bring up on call?!

Today's topics:

PACIO ADI 

• Goal is to identify the proper resources for patient preferences
• Slides: 
• There are three types of ADI
  • Type 1 - Patient authored ADI - what do they want for a future event.
  • Type 2 - Practitioner authored Encounter Centered Instruction - practitioner
  • Type 3 - Practitioner/Person for portable constables
• Preferences are not just for end of life.  Need to align across align when using FHIR resources.
• The IG is focused on the US (sponsored by CMS).  If it were international, there is a concern some may not fit with certain countries.
• Slide 12 summarizes the direction that PACIO is heading for the publication.
• There are concerns with just using FHIR Observation for the Type 1 ADI.
  • Observations are frequently used as an easy mechanism to put various information, but where there are other constructs available that fit better, that should not be done.  Observations are primarily around assertions about current things, although can cover past recollections.  Goals are available, so using Observations for what essentially are goals would be a concern.  Similarly for ServiceRequest and other requests.
  • Goals are indicated to not be feasible as FHIR US Core requires support for a start and target date.  That would require an exception.  That may actually not be that difficult to obtain and should not be considered a limitation.
  • ServiceRequest are a challenge as they seem to be focusing orderables, yet nothing is being ordered, as well as systems may get confused on what it represents.  However, a concern with that is that it mis-represents ServiceRequest and does not realize that it has the relevant context.  The ServiceRequest does not assume it will be done: it is a request, it may be denied.  A patient can be the author.  And in the context of a patient authored CarePlan it should be clear to any system that it is not a clinical order.
• There is agreement that FHIR Consent is not appropriate beyond the limited use to affirm that another person can make decisions on behalf of the patient with a power of attorney (or similar documentation).
• PACIO seeks further feedback by way of this Jira ticket ( FHIR-35078 ) or this Zulip chat as soon as possible.  They are not seeking an OO vote.
• It was noted that USCDI v4 may include preferences if not ADI as a type of care plan.  If so, the topic would then be further discussed in FHIR US Core as to how to include it and a number of these topics would come up.

WGM Agenda

• Joint meeting with PH WG early in the week? - will prep draft agenda and respond back next week: OO WGM 202309 - Agenda - Orders & Observations - Confluence (hl7.org)
• We also have this page to move topics over: 2023-09-11-15 WGM
• Need to work with FHIR-I or Vocab on the following: 
  • FHIR-40437 - Link missing -  Note this is the expansion list

September Connectathon Participation

• 2023 - 09 Orders Exchange Track only

Catalog

Discussed ProfileForCatalog on July 7th Catalog call and have the following recommendation

• This profile is self contained - i.e., the sections (listing of healthcare items) are part of the profile 
• The goal is to have a structured representation of the sections as in the Catalog IG
• We recommend deprecating the ProfileForCatalog by R6 and add a pink ribbon comment on the ProfileForCatalog to inform implementers to move to the Catalog IG for guidance
• Need review from more OO members to determine if this course of action is ok:
  • Marti Velezis to make a Jira to add the pink ribbon once the IG is published so we can directly link to the IG.
  • will bring back up when OO reviews the publication request - goal is July 27 main call

Update on FHIR Tracker related to family attributes

• Created matrix - see: 2023-07-18 OO on FHIR 
• discussion is generating additional Jira tickets
• will continue next week on OO on FHIR call July 24, 2023 2-3 PM ET
• will bring recommendations from these calls to the main call when compiled

privacy/consent/workflow zulip topic in v2

• https://chat.fhir.org/#narrow/stream/179256-Orders-and-Observation-WG/topic/privacy.20.2F.20workflow.20with.20commercial.20labs
• this refers to this stream: https://chat.fhir.org/#narrow/stream/229447-V2/topic/privacy.20.2F.20commercial.20lab.20workflowshttps://chat.fhir.org/#narrow/stream/179256-Orders-and-Observation-WG/topic/DiagnosticReport.20statuses.20and.20CLIA.20requirements.3F as the use case
• Further discussion at last Lab call clarified that the underlying standards could handle the variety of interactions that an implementation guide could address:
  • ADT messages are always sent and the order message has limited demographic data - typically when the lab system is internal to the provider
  • Order messages are sent with all the demographics needed, while ADT messages are never sent.
  • Order messages are sent with all the demographics needed, and only then will ADT messages start to be sent (like a subscription) moving forward
  • Order messages are sent without demographics beyond an identifier that enables results to be linked back to the correct patient.
• There is no further action for OO to take.

Diagnostic Report and CLIA Zulip

Zulip chat: https://chat.fhir.org/#narrow/stream/229447-V2/topic/privacy.20.2F.20commercial.20lab.20workflowshttps://chat.fhir.org/#narrow/stream/179256-Orders-and-Observation-WG/topic/DiagnosticReport.20statuses.20and.20CLIA.20requirements.3F

Links:

• Reviewed and made edits to the following: https://docs.google.com/spreadsheets/d/1PZzztfsx_yRfvrl3i9on8Tc-yXZCzbK1wnVgts-SxSQ/edit#gid=0
• Status in FHIR: http://hl7.org/implement/standards/fhir/codesystem-diagnostic-report-status.html

Possible LRI Newborn Screening (NDBS) change request

• Would like to discuss options for updating the LRI NBS grouping requirements - we will take up this topic on July 28th on the lab call 1 -2 PM
• There are also some jiras for LOI and LRI NDBS Component we should look at at that time

Adjourned at 2:02 PM ET - below not discussed

FHIR jiras

Discussing the pulled items:

• • FHIR-41426 - Need to reach out to Javier Espina and find a Main or OO on FHIR timeslot.
  • FHIR-25552 on TBD based on Daniel Rutz  preference.

• Check back in June for progress

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 Dashboard 

• V2.9.1 related comments:

  • https://jira.hl7.org/browse/V2-25404

  • https://jira.hl7.org/browse/V2-25411

  • https://jira.hl7.org/browse/V2-25391
  • https://jira.hl7.org/browse/V2-25401

h

Discussion Topics: 

JIRA 

Block Vote of old Jira trackers set for next main call - see: https://confluence.hl7.org/pages/viewpage.action?pageId=161072874#id-20230504Main-OOonFHIRBlockVote(senton4/26/2023)

The following are draft pages to organize and author content for each of our health care product resources: 

• BiologicallyDerivedProduct
• Devices
• Nutrition Product
• VisionPrescription

OO Resource Coverage

• Need to discuss developmental roadmap for each of the OO resources for R6
• Added R6 planning to WGM agenda
• Need to discuss what needs to be done prior to WGM to prep for discussions
• Add Resource reorg comments to module pages

Notes

• Marti revised related resource for each topic area to where the resources align to current modules
• Definitional resources were in workflow (pattern is still there) but those are now in administrative – Marti and Jose to take off-line