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Attendees: JD Nolen (Mercy Children's Hospital), Rob Hausam (Hausam Consulting), Ralf Herzog (Roche), Dan Rutz (Epic), Marti Velezis (FDA), Andrea Pitkus (UW), Hans Buitendijk (Cerner), Riki Merrick (Vernetzt, LLC / APHL), Ed Heierman (Abbot), Amy McCormick 


Topics:

  • LIVD
    • Updates on progress
      • Various JIRAs have been applied and diagrams have been updated.  Not yet complete.
        • Content moved into fsh format
        • Should cull base content from the IG
        • Hans reviewed all open jira/ballot spreadsheet for typos and sections
          • Page content has been split out into smaller parts for general principles, so we get the drop down for the tab – Rob to do that
          • Updated the publication structure diagram
          • Got material from Ed for mapping detail – Hans will apply
          • Andrea, Pam and Riki working on example updates
          • Andrea and Pam working on display consideration updates
        • Code system fragment – where should that be – is not in fsh folder (because that cannot accommodate this resource quite yet)
        • Jira’s that Hans needed guidance from Rob – these are assigned to Rob with a comment
        • Look for LIVD assigned comments in any status
        • Some of the comments are not as enhancement requests, so it is not giving us disposition and other workflow boxes – they are missing “change still needs to be applied” – these have status answered
      • Will have an updated build for next week to review.
    • We need to review next steps for: 
      • FHIR-18130
        • observationDefintion – datatype – can one observation really support more than one datatype – assume this should be 0..1
        • Rob will be checking this
      • FHIR-18270
        • We agreed to get the creation, usage, and aggregation phases summarized on how to use the artifacts based on current experience.  Over time we can further refine based on actual usage.
        • Step by step guide how to use each artifact following an example use case
        • looking for implementer input on what would be helpful
        • looking for a volunteer to write this up
        • Ralf and Ed created the example bundles – how did you do it?
        • Hans and Ed on how to use the LIVD on consumer side
        • Riki on how to use it as aggregator for a specific use case
        • Maybe explain how the spreadsheet is being used now to create the resources
        • Marti will see, if she can review with fresh eyes
      • FHIR-24436 
        • catalogEntry – we are not using it in the end, because the resource no longer exists
        • Motion to re-open.  Riki Merrick, Rob Hausam, no further discussion
          • Against: 0; Abstain: 0; In Favor: 11
        • Motion to find not persuasive as FMG did not approve the resource. We will investigate as well that we can switch to using the Catalog Profile as the basis rather than Composition directly.  Rob Hausam, Riki Merrick, no further discussion
          • Against: 0; Abstain: 0; In Favor: 11
      • FHIR-26936 - Not discussed
    • Block Vote Being Build
  • US Core Block Vote
    • e reviewed those related to Observation and DiagnosticReport and concluded that OO does not agree with finding https://jira.hl7.org/browse/FHIR-28389 persuasive and  FHIR-28385 - Getting issue details... STATUS  not persuasive.

    • We will follow-up with CPG to schedule a time to discuss.
      • hasMember Vital Signs Panel Profile Reference Choice / hbuitendijk / Persuasive with Modification / https://jira.hl7.org/browse/FHIR-28391
        • No change to the underlying approach
      • value[x] for Lab Data Type Choice / hbuitendijk / Persuasive with Modification / https://jira.hl7.org/browse/FHIR-28390
        • Survey is in progress to decide on the must support datatypes, the rest would be optional
      • effective[x] for Lab Data Type Choice / hbuitendijk / Persuasive / https://jira.hl7.org/browse/FHIR-28389
        • Date is MustSupport – period is optional
        • Has anyone reviewed these resources for CLIA compliance, since this is supposed to be US
        • Suggest someone should pull this
      • effective[x] for Note Data Type Choice / hbuitendijk / Persuasive with Modification / https://jira.hl7.org/browse/FHIR-28387
      • effective[x] for Lab Data Type Choice / hbuitendijk / Not Persuasive / https://jira.hl7.org/browse/FHIR-28385
        • Difference in how US core defines this element compared to the base
        • US core should not change the definition of the base – since the diagnostic report has more than one observation this is much too restrictive
        • Hans has already pulled this one and this group agrees
        • This will be discussed on the call Cross-Project 1 -2 PM ET – can we request a joint meeting for the pulled items?
        • The base definition could also use some clarification
      • performer for Lab Reference Choice /hbuitendijk /Persuasive /https://jira.hl7.org/browse/FHIR-28378
        • Explain what is must support
      • Enhance US Core Diagnostic Report Laboratory Codes value set Definition / jwsnyderdh / Not Persuasive / https://jira.hl7.org/browse/FHIR-26057
  • LRI Ballot Reconciliation - Not discussed
    • See updates to the spreadsheet here: https://confluence.hl7.org/download/attachments/76152954/V251_IG_LRI_R1_D5_2020SEP_consolidated.xls?api=v2
    • #112 – Riki to still do Follow up on basecamp around OBX-17
    • Filtering on A-S
      • #6 – Motion to find persuasive – Riki Merrick, Craig Newman, further discussion: AOE description should be drawn from LOINC – how to handle if the lab has their own description – move this out of this item – Andrea to send updated suggested language as starting point – against:0, abstain: 0, in favor: 10
      • #8 - Motion to find persuasive – Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 10
        • The bullet below this has a typo – need to
      • #10 – Remove the special call out of Table 4-5, as all of the tables in Section 4.3.3 apply for result reporting; motion to find persuasive with mod– Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 10
      • #9 - Motion to find persuasive – Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 9
      • #11: Motion to find persuasive – Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 9
      • #12 – Motion to find persuasive with mod – move the IF statement to the bottom and append the proper location of where to provide ordering facility information, Namely in ORC-21 – ORC-23 – Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 9
      • #14 - Motion to find persuasive – Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 9
      • #15 – Motion to find persuasive with mod since this refers to the HHS element naming – using the convention used in the pdf: https://www.hhs.gov/sites/default/files/hhs-guidance-implementation.pdf – Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 9,
      • #16: When a LOINC code is… instead of “as long as” - Motion to find persuasive with mod - Riki Merrick, Craig Newman, no further discussion, against:0, abstain: 0, in favor: 8
      • Need to find a time that Kathy can make to deal with in-person comments
      • Andrea’s item: The ask is whether the 3rd bullet from Craig/Riki's comment is indicating that the LOINC description for an AOE is the only option for reporting. (It says should so I think it would be ok if a lab has it's own flavor of the question they have CLIA validated and included for their test order.)  Unfortunately I couldn't see where the items are located as you'd know from where you are screen sharing. 
      • Would apply to the current item too as Hans called out.
  • HHS reporting:
    • NHSN is now the mandated mechanism for LTCF lab result reporting to HHS: https://www.hhs.gov/sites/default/files/covid-19-laboratory-data-reporting-guidance.pdf
      • NHSN has built a web application to collect this information
      • NHSN is using AIMS to forward collected data in ELR R1 messages to the state PHAs based on patient state
    • Pooled specimen update
    • NY
      • Reporting of school information (as employer or student, and attendance/present in last 7 days).
      • No further updates from NY as of yesterday.
      • Need to be considered in counts about health workers at a university hospital vs. an employee of a university, and whether the contact of interest around contact with students vs. patients.
      • Hans to include latest document.
    • OR
      • Hans to drop in the Oregon links/files into last week and then drop this bullet here.
      • It will not be part of ELR, rather .csv and perhaps eCR in the future.