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AGENDA

• e-Signature
• LIVD - Time requested this week
• CPT-PLA - Time requested this week
• R5 Ballot JIRAs (carry over from 10AM Call)
• AOB
  • New rule on Race/Ethnicity from OMB

Standing Topics

• eSignature Update: The following CMS rule has been released: Title: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard; Scheduled Pub. Date: 12/21/2022; Permalink: https://www.federalregister.gov/d/2022-27437.   
  • it does include commerce law language allowing a symbol as substitute as described to us by John Moehrke
  • ACLA had a call with ONC representative to remind them that we still have to resolve this – it will affect ALL existing interfaces in the orders and the results
  • Hans to give PAC a heads up that OO will provide feedback on this
  • Add to agenda at WGM or first call after WGM...  If during the WGM, will reach out to Freida to join.
  • Comments Due March 21, 2023 (when are comments due to PAC?) 
  • [2023-02-03 Discussion] 
    • Scope is vague for lab orders - and need to continue discussion next two calls (time permitting)
    • General definition - currently v2 should work and no changes need to be made. 
• New Rule on Race/Ethnicity from OMB
  • Federal Register :: Initial Proposals For Updating OMB's Race and Ethnicity Statistical Standards  https://www.federalregister.gov/documents/2023/01/27/2023-01635/initial-proposals-for-updating-ombs-race-and-ethnicity-statistical-standards  
  • <from chat> Hans mentioned “trickle down” - the reason we had race and ethnicity terms added in HL7 started with V2 is because CDC requested Patient Administration (Chpt. 3) to add (HL7 V2.4 I think) because CDC had to conform to federal requirements.  The same terms used for Census Bureau data ‘trickled over’ to other federal agencies.  If this new request for comment proceeds to a new proposed then final rule, it would probably “trickle down” eventually impacting CDC, ONC, CDC (thus eventually healthcare standards) etc.  See 1997 link and you will recognize correlation to HL7 V2 of race and ethnicity.  Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity | The White House (archives.gov) https://obamawhitehouse.archives.gov/omb/fedreg_1997standards
• Update from FHIR Lab Workflow call
  • Hold until R5 Ballot comments are addressed
• LIVD
  • Updates from Ed
  • ObservationDefinition Tab - 
    • removed code.coding.verison in the template as it is not needed 
    • No cardinality for code.coding.display - add 1..1 to template
  • TestCodeConcept Map Tab
    • Remove url (column B) from template
    • version 1..1 becomes column B)
    • Replace name with description (0..1) - it is not mapping to anything and is not needed; should this be optional?
      • name, title and description are options to be used
      • Description is better to handle additional information about the concept map
    • Do we need targetUri or only within Group? 
      • ConceptMap.targetUri (valueSet)
        • Change to 0..1
      • group.element.target.targetUri (codeSystem)
        • Keep 1..1
      • How do you manage with these elements to prevent crossing incorrect relationships between these two elements
      • Group.target
        • intended to represent "LOINC" (http://loinc.org) and not as a GUID
      • Group.target.version
        • would indicate the specific version of the value set
      • Guidance - we need to create a valueSet and put in the Group.target.targetUri (as a GUID)
    • Need to follow-up
    • Ed can be back with LIVD February 17, 2023 (not available on 2/24 or 3/3)

----------Adjourned at 2PM EDT---------------------

• ISA = LOINC/SNOMED/CPT PLA - NEXT WEEK (if not later today)
  • Proposal being prepped by: Nancy Spector, Ana Szarfarm, Kathy Walsh, Andrea Pitkus, Hans Buitendijk, Dan Rutz
  • OO Lab and CPT PLA
    • PLA = Proprietary Laboratory Analyses
    • It is not messaged between healthcare organization
    • Nancy will ask AMA to review this content
    • Discuss should this be on this webpage?
      • Any data that is associated with a patient outside of internal analytics in a specific system that will be exchanged
      • Laboratories that have inventory / catalog and submit this to CMS, so this has applicability to interoperability – so yes, we agree it should be in the ISA
      • May need to evaluate if this is in the right use case
        • One health system uses the PLA codes internally for ordering of lab
        • We may need to make clear that LOINC is the primary code and that PLA codes can be used similar to local codes – this could be done in the LOI guide?
          • No, we don’t want to have everyone’s option explained in the LOI – this would be explaining how NOT to use PLA codes …
    • Next Steps:
      • Describe the proper use of these codes, which is categorizing the type of order available on the lab system, not to order a test on a patient sample – Nancy to verify with AMA and possibly write clear user guidance on how these codes are intended to be used
      • Once we have that, then decide if we request for ONC to create a separate use case page for sharing this vocabulary
    • This is expecting that PAMA legislation (with cuts for labs) will be passing

R5 Ballot JIRAS

ServiceRequest

• FHIR-28410 - ServiceRequest relation to ActivityDefinition and PlanDefinition is ambigue
  • Resource includes instantiatesCanonical and instantiatesUri and those should be removed in the future – We will add clarification of ActivityDefinition and PlanDefinition in the Comments on the current instantiatesCanonical as well as text in the Boundary/Relationship section of the SerivceRequest resource.
  • Note: SupplyRequest, DeviceRequest, NutritionOrder should remove instantiatesCanonical and instantiatesUri to follow Request Pattern we will create a new JIRA to get these resources updated Marti Velezis 
  • Motion to find Persuasive
    • JD Nolen / Marti Velezis : 8-0-6
    • Assigned to JD Nolen

-------------Did not get to the following-----------------------

Observation

• Technical Corrections (No votes needed, but review and dispositions are still pending) 
  • FHIR-38955 - A constraint expression is not specifically enough defined
    • Disposition proposed - in "waiting for input" 
  • FHIR-38956 - Unclear statement
    • Text under DiagnosticReport.result
  • FHIR-38924 - observation-replaces extension: expected behavior not clear
    • Needs disposition

DiagnosticReport

• FHIR-25995 -Consider how to communicate imaging status history
  • Note - this is a May 2021 Ballot comment that was never resolved - should this be included in R5??