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Meeting Notes

Standing Topics

• COW/FOE Recap
• Discuss CPT/PLA and ISA comments
  • Representing Laboratory Test Ordered discussed.

JIRA Issues/Discussion Topics

• ObservationDefinition.qualifiedInterval.condition 
  • Zulip chat: https://chat.fhir.org/#narrow/stream/179256-Orders-and-Observation-WG/topic/ObservationDefinition.2EqualifiedInterval.2Econdition
  • Two issues:
    • ?? (missed that)
    • Observation.interpretation value set not able to align with ObservationDefinition.qualifiedInterval to indicate for the observation definition which values in observation interpretation code system
      • We need to enhance the qualifiedInterval backbone to address both valid reference ranges (numeric and qualitative) and associated interpretations from the larger observation interpretation code code system.
      • Rahul will provide a JIRA with a suggestion on how to enhance ObservationDefinition.qualifiedValue to reflect both needs more complete and more clear. 
        EDIT: JIRA ticket FHIR-41949 - Getting issue details... STATUS
    • ObservationDefinition.qualifiedValue
      • value[x]
        • range  (numeric)
        • codedValueSet (qualitative)
      • normal/abnormal/critical/.... 
        • range
        • codedValueSet
      • interpretation
        
        • Positive - positive/negative/.....

--------Backlog of Topics---------

• DiagnosticReport.status
  
  • Zulip chat: https://chat.fhir.org/#narrow/stream/179256-Orders-and-Observation-WG/topic/DiagnosticReport.20statuses.20and.20CLIA.20requirements.3F

  • Status in FHIR: http://hl7.org/implement/standards/fhir/codesystem-diagnostic-report-status.html

  • v2-FHIR Mapping Spreadsheet: HL7 Concept Map: ResultStatus[Non-Queries] - Google Sheets
  • 8/4 - Summarized the discussion from OO Main call and ran out of time. 
    • See links in Chat below
    • Still need a bit of clarification
    • Reviewed CAP Checklist from 2023
      • Corrected/correction - A change in a previously issued clinical pathology test report intended to correct an
        inaccuracy, including changes in test results, patient identification, reference intervals, interpretation, or other
        content.
•  Micro
  • Craig's v2 micro question: https://confluence.hl7.org/pages/viewpage.action?pageId=161080303#id-20230518Main-Subject:"v2discretemicroquestion"-Listservemessage(fromCraig)
  • The OBX-30 Observation Sub-Type Enhancements - Orders & Observations - Confluence (hl7.org) was created, and as it was created identified that various values were actually deleted, and examples were available for most but not all sub-types.
  • We reviewed the current wording and examples and updated the page with suggested adjustments (in red for text not in the published version and strikethrough where text is suggested to be removed)
  • Craig updated the example (Micro Example) using only the active/new values.
  • Open questions for next week:
    • Any other updates to the definitions/descriptions to clarify?
    • Any examples that would primarily be using MOD?
    • Any examples that could use either use MID or MOD?  We discussed PCR, but that raised questions whether is actually confusing and would require further explanation as for some it would never be used with MID.
    • Andrea had suggested that a more complex example she described would be helpful, but a volunteer to create that has not yet been identified.
    • No update
• Panel/Micro and discoverable Observations in FIHR
  • Hans/Fran to create an initial proposal, focusing on the micro scenario, on how to approach this in FHIR / FHIR US Core.
    • No update

• Other JIRAs from Triage Inventory - Not discussed

Chat History

Andrea Pitkus, PhD, MLS(ASCP)CM, FAMIA. UW-Madison to Everyone (Aug 25, 2023, 1:08 PM)
Specimen reject reason is in specimen definition per catalog
but not on FHIR specimen currently
 
Andrea Pitkus, PhD, MLS(ASCP)CM, FAMIA. UW-Madison to Everyone (Aug 25, 2023, 1:18 PM)
There's test order (noun, term built in LIS or EHR which is selected by the provider), versus ordering process (the physician order/requisition).
Also Representing the test ordered, may imply semantic meaning.  What is being represented.
The physician order/requisition is different than the term built in the LIS/EHR dictionaries with item selected.
 
Nancy Spector (AMA) to Everyone (Aug 25, 2023, 1:24 PM)
https://www.ama-assn.org/system/files/cpt-pla-codes-long.pdf
These test descriptors include specifics about test being performed
 
Andrea Pitkus, PhD, MLS(ASCP)CM, FAMIA. UW-Madison to Everyone (Aug 25, 2023, 1:25 PM)
Each laboratory's test compendium is linked/provides info as to the different orders on their menu, but they are not included here
how would PLA codes provide enough detail for interoperability?  EHRs are required to have LOINC functionality

Andrea Pitkus, PhD, MLS(ASCP)CM, FAMIA. UW-Madison to Everyone (Aug 25, 2023, 1:48 PM)
https://www.mayocliniclabs.com/test-catalog/overview/602752#Clinical-and-Interpretive
Ref ranges that the lab may not be able to interpret
These may not work with this approach

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 - As soon as Dan has proposal.

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
• FHIR- 32154 - Pending outcome of DiagnosticReport/Observation/Panel discussions