Orders & Observations

January Working Group Meeting

January 14-18, 2013

Meeting Minutes Table of Contents

ATTENDEES...... 4 MONDAY...... 6 Q1 – OO...... 6 Agenda...... 6 Introductions...... 6 WGM Agenda Review...... 6 Project Review...... 6 SWOT...... 6 Q2 – OO...... 7 Agenda...... 7 Nutrition...... 7 V2.8 Ballot Reconciliation...... 7 Q3 – OO...... 7 Agenda...... 7 V2.8 Ballot Reconciliation...... 7 Q4 – OO/Pt Care...... 7 Agenda:...... 7 Update from Allergy/Intolerance...... 8 Update Care Plan...... 8 V2 Issues with Pharmacy...... 8 Joint meeting with CDS – Change of Quarter and day...... 8 V2 PSS for public health approval...... 8 TUESDAY...... 9 Q1 – OO...... 9 Agenda...... 9 V2.8 Ballot Reconciliation...... 9 LOI Ballot Reconciliation...... 9 Q2 – OO + Rx + Pt Safety + RCRIM + PHER...... 9 Agenda...... 9 Nutrition...... 9 Allergies...... 9 Common Product Model...... 9 Substances Model...... 10 FHIR Resources Product & Device...... 10 PHER Updates...... 10 Q3 – OO...... 10 Agenda...... 10 Specimen...... 11 Q4 – OO...... 11 Agenda...... 11 LOI IG Ballot Reconciliation...... 11 WEDNESDAY...... 12 Q1 – OO/II/AP/CG...... 12 Agenda...... 12 AP/II...... 12 Specimen ID...... 12 Integrated Lab Workflow...... 12 OO...... 13 Specimen model update...... 13 FHIR update...... 13 CG...... 13 Terminology question...... 13 Clinical Sequencing DAM...... 13 Q2 – OO + FHIR...... 13 Agenda...... 13 Resource Review...... 14 Q3 – OO...... 15 Agenda...... 15 Lab Model Ballot Reconciliation...... 15 Q4 – OO...... 15 Agenda...... 15 Table 0078...... 15 Lab Order DAM Ballot Reconciliation...... 15 THURSDAY...... 16 Q1 – OO...... 16 Agenda...... 16 FHIR Ballot Reconciliation...... 16 FHIR Next Steps...... 16 LOI IG Ballot Reconciliation...... 16 Q2 – OO/CDS...... 16 Agenda...... 16 Order Sets...... 16 Order Service...... 17 Q3 – CS/OO...... 17 Agenda...... 17 Ballot Reconciliation...... 17 FRIDAY...... 19 Q1 – OO...... 19 Agenda...... 19 WGM Survey Input...... 19 Attendees Please contact Hans Buitendijk (OO co-chair) in case your name or e-mail is misspelled, or the attendance is not checked appropriately.

Name Company/E-Mail Monday Tuesday Wednesday Thursday Friday Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 Tanya Achilles [email protected] √ √ Meya Achdrat [email protected] √ Elaine Ayres [email protected] √ √ √ Ginger Belvin [email protected] √ Stephanie Broderick [email protected] √ √ Aziz Boxwala [email protected] √ Hans Buitendijk [email protected] √ √ √ √ √ √ √ √ √ √ √ √ √ Jamie Cash [email protected] √ √ Chengjian Che [email protected] √ Stephen Chu [email protected] √ √ √ √ Lorraine Constable [email protected] √ √ √ √ √ √ √ √ √ √ √ √ √ Julie Crouse [email protected] √ Clayton Curtis [email protected] √ Steve Daviss [email protected] √ √ Lori Dieterle [email protected] √ √ √ √ √ √ √ √ √ √ √ √ √ Jean Duteau [email protected] √ √ Attilla Farkas [email protected] √ √ Jon Farmer [email protected] √ Maree Ferguson [email protected] √ √ Emory Fry [email protected] √ Chiara Gelinas [email protected] √ Maggie Gilligan [email protected] √ Hugh Glover [email protected] √ William Goossen [email protected] √ √ √ √ Grahame Grieve [email protected] √ √ Lars Gunnar [email protected] √ Hartveit Eric Haas [email protected] √ √ √ √ Freida Hall [email protected] √ √ √ √ √ √ √ √ √ √ √ Rick Haddorff [email protected] √ Rob Hausam [email protected] √ √ √ Peter Hendler [email protected] √ Kay Howarter [email protected] √ Julie James [email protected] √ Kensaku Kawamoto [email protected] √ Andrzej Knafel [email protected] √ √ √ √ √ Christina Knotts [email protected] √ Helmut Koenig [email protected] √ Tom Kuhn [email protected] √ Victor Lee [email protected] √ Michael Legg [email protected] √ √ √ √ √ √ √ √ √ √ Russell Leftwich [email protected] √ Amy Light [email protected] √ √ √ Patrick Loyd [email protected] √ √ √ Cem Mangir [email protected] √ Michael Martin [email protected] √ Ken McCaslin [email protected] √ √ √ √ √ √ √ √ √ √ √ √ Clem McDonald [email protected] √ √ Jeroen Medema [email protected] √ Bob Milius [email protected] √ Bernadette Minten [email protected] √ Scott Moss [email protected] √ Galen Mulrooney [email protected] √ Claude Nanx [email protected] √ JD Nolen [email protected] √ √ Brian Pech [email protected] √ KD Pool [email protected] √ √ √ Name Company/E-Mail Monday Tuesday Wednesday Thursday Friday Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 Gordon Ranp [email protected] √ Bryn Rhodes [email protected] √ Scott Robertson [email protected] √ √ √ √ David Rowed [email protected] √ √ Dmytro Rud [email protected] √ √ √ √ √ √ Amnon Shabo [email protected] √ √ √ Rik Smithies [email protected] √ Robert Snelick [email protected] √ Harry Solomon [email protected] √ √ Davide Sottara [email protected] √ Howard Strasberg [email protected] √ Michael Tan [email protected] √ Sheryl Taylor [email protected] √ √ √ √ √ Mike Tushan [email protected] √ Mollie Ullman- √ Cullere [email protected] Stephen Vastagh [email protected] √ Daniel Vreeman [email protected] √ √ Crystal Wolfe [email protected] √ √ Bob Yencha [email protected] √ √ √ √ Hisao Yoshimura [email protected] √

Communication with declared O&O participants can be done through [email protected]. You can sign up through the HL7 website, www.hl7.org. List servers for focused aspects of the O&O domain are: [email protected], [email protected], [email protected], [email protected], [email protected] , [email protected], [email protected], [email protected], and [email protected]. Monday

Q1 – OO

Agenda  Introductions  WGM Agenda Review  Project Review  SWOT

Introductions Went around the room.

WGM Agenda Review Updated the agenda:  Added SWOT to Monday Q1  Added V2.8 Ballot Reconciliation to Monday Q2 as we probably will run short  Added V2.8 Ballot Reconciliation to Monday Q3  Added LOI Ballot Reconciliation to Tuesday Q1  Added various project updates to Tuesday Q2  Added AP’s proposed order workflow project to Wednesday Q1

Sent out updates to the OO list. Need to get the updated agenda to the mobi-app. Hans to check with HQ staff.

Project Review  Various Updates (from Project Insight) o 38 – Composite Order – Updated milestone dates. o 111 – Observation Request Template – Updated milestone dates o 585 – Harmonize Medication Order with Composite Order – Updated milestone dates o 587 – Lab Order Template – Updated milestone dates o 682 – Specimen CMET V2 – Updated milestone dates o 738 – Diet and Nutrition Orders DAM – Archived as it is complete. o 792 – LRI IG - Archived as it is complete o 892 – Specimen DAM – Updated milestone dates o 902 – Nutrition Order – Updated milestone dates o 922 – LOI IG – Updated milestone dates  New projects to be established o LRI IG V2 Normative PSS – Ken/Hans o eDOS IG V2 Normative PSS – Freida/Patrick

D:\Data\SROs\HL7\ Orders-Observations\OO SWOT Analysis 201301.doc o o Motion to accept the SWOT as documented . Against: 0; Abstain: 0; In Favor: 8 Q2 – OO

Agenda  Nutrition Ballot Reconciliation  V2.8 Ballot Reconciliation

Nutrition  Accept all suggested resolutions for A-S, A-T, and A-Q from the Academy submitters. o Against: 0; Abstain: In Favor: 14  See spreadsheet attached for ballot reconciliation.

V3_ORD_DIETNUT_R 1_D1_2013JAN_Amalgamated.xls o

V2.8 Ballot Reconciliation

 Request by Vassil Peytchev to consider his comments as he is not in the ballot pool due to missing sign- up in a prior version.  It is not clear why he did not make the prior ballot round(s).  Motion to not accept his input as it was not on time. Ken McCaslin, Scott Robertson o Discussion: If we were to accept, we could not accept any of the negatives as that would create ballot process problems. o Against: 0; Abstain: 0; In Favor: 10  Motion to allow editors to resolve the A-Ts. Hans, Ken o Against: 0; Abstain: 0; In Favor: 11  Attached is the ballot reconciliation spreadsheet including all issues addressed.

D:\data\SROs\HL7\ V2\V280\ballotcomments_v28_n3_2013jan_amalgamated.xls o

Q3 – OO

Agenda  V2.8 Ballot Reconciliation

V2.8 Ballot Reconciliation  Due to lack of quorum in the early part, focus was on preparation/suggestions for resolutions.  Once quorum was achieved, various dispositions were agreed to.  See the spreadsheet referenced in the Monday, Q2, V2.8 Ballot Reconciliation section for details.

Q4 – OO/Pt Care

Agenda: 1. Update Allergy/Intolerance

2. Update Care Plan

3. V2 issues with Pharmacy 4. V2 PSS for public health approval

5. Joint with CDS change Quarter and Day – the CDS co-chairs are only at HL7 2 days typically

Chair: William Goosen Scribe: Ken McCaslin

Update from Allergy/Intolerance Balloted DAM this cycle, currently doing ballot reconciliation (informative ballot), like to do one more ballot before moving on to a DSTU (2014 at the earliest). Not sure they want a dependency in the project to continue to be driven by the diet piece of the project. Did update their uses cases. Do not believe there are any other dependencies on behalf of OO, but there is likely some FHIR dependencies. The issues around criticality and it has been contentious. Severity is also an issue. It defined the response to a reaction. Allergy/Intolerance is a very broad issue and there are issues around the difference between these two issues and how it is properly distinguished one from another. More of definitions problem and less of a vocabulary issues.

Update Care Plan Since last report completed several uses cases, formalizing DAM for informative ballot in May 2013, have a straw man model for care plan structure. Been debating the care plan versus the plan of care. Are there structural differences between care plan versus plan of care? Patient and family agreement on the intervention plan or interactions. Working with SOA to determine how to coordinate various providers on more than one care issues. How to manage the different care issues and coordinate the issues acros various organizations. Have two projects to drive these issues. Targeting the DAM to be informative in May 2013, September Care coordination services ballot together. Considering using FHIR and have committed to look at for Care Plan. Manage items through ballot comments.

V2 Issues with Pharmacy Australia developing prescription, dispense record, Prescription request. Ability to have patient known with pharmacy to have additional medication dispense without a prescription because there is not enough time to contact the physician, so the dispense is done prior to approval from the physician. Have developed logical model for this. Want to map it to HL7 version 2.4. Wants guidance to resolve the mapping from pharmacy to V2.4. they have a dispense record, need the details about the. We think this can be solved using by early adopting the PRT segment into their IG. Prescription timing range need to expand the concepts of timing. It looks like there is limitations in TQ1/TQ2. We think they need the V3 concepts.

Joint meeting with CDS – Change of Quarter and day We need to meeting with CDS to determine the best time to meet with them They are not coming on Monday. Can we move this to Tuesday, Wednesday and Thursday. Patient Care can meet with us Monday, is there benefit for PA and CDS meeting jointly with CDS? Or does this need to be just representatives to meet? We will target moving the PC joint to be Thursday Q1 for joint of PC & CDS.

V2 PSS for public health approval Release 2 of the ELR guide. It needs to be reviewed by CGIT which was done earlier today. Changes from last time we reviewed.

PSS_ELR_r4_WGMCo mments.doc Motion by Eric Haas. Second by Ken McCaslin to accept the changes to the project scope statement. Favor: 15; abstain: 0; against: 0 Tuesday

Q1 – OO

Agenda  V2.8 Ballot Reconciliation  LOI Ballot Reconciliation (if time permits)

V2.8 Ballot Reconciliation  See the spreadsheet referenced in the Monday, Q2, V2.8 Ballot Reconciliation section for details.  We will continue Friday morning with the last open item.

LOI Ballot Reconciliation  We did not have time to progress this.

Q2 – OO + Rx + Pt Safety + RCRIM + PHER

Agenda

 Nutrition  Allergies  Review Joint projects - Common Product Model, Substances....  FHIR Resources Product & Device  PHER

Nutrition  Completed the Nutrition ballot reconciliation for January.  Need to get the harmonization through.  May not get back into May 2013 due to timing/bandwidth around harmonization.  Note that Nutrition Orders showed up twice. Will be fixed as part of next.  Most harmonization will go into Act Code domain.  When we have the harmonization proposal(s) will run through both OO and Rx. o Rob Hausam will manage the process.  If you can get good concept definitions with 3 examples, should be good enough.  The allergy aspect is pending the Allergies project. Only used a small slice, but needs to be worked in. o Suggest to take a best guess at times as local vocabularies will be predominant.

Allergies  This is the project out of Pt Care with OO and Rx as co-sponsors.  First Informative DAM ballot this round.  About 80 comments.  Challenges how to model preferences.  Moving slow, but renewed interest due to various national programs and patient safety

Common Product Model  Projects needing to use R2B can do so.  If needed both, had to declare.  R2B ballot process is moving through.  Task Force recommendation is moving from TSC to Board.  Once passed, need to reconcile with CPM and there are IDMP harmonization tweaks required.  As soon as we have the findings and ballots resolved, CPM needs to go back to ballot.  Made various changes to the CPM Project 858 to reflect May as target to have final Normative ballot round.

Substances Model  Last ballot in May 2010 (DSTU)  Waiting for R2B and IDMP, similar to CPM.  Needs to go back out in May or shortly thereafter to close out DSTU rounds and get it published.  Hans to contact Gunther to get this on track.  Believe that Substances need not be rushed to Normative, rather get some good implementation experience.

FHIR Resources Product & Device  Rx will cover prescription for drugs.  There is a grey area for prescribing devices.  Do we want to create a FHIR “CPM” resource? Or do we want to create one just for the core data in CPM, separating out the core from the very long tail. Non-core would become extensions in FHIR.  Similar as medications, may not always need a separate resource as the identifier may be sufficient.  Do we need a product resource in the 80% FHIR scope. o CPM is of more interest to regulators, not direct care processes where FHIR is focusing, so may not need it.  Suggest to have joined OO/Rx FHIR calls to resolve boundary issues. Will be addressed with FHIR project team to figure. o Suggest to complete Rx FHIR first and then have the joint conversation. o  Key questions on what to focus on first: V3 or FHIR.  Rx worked on o Administration o Dispense o Starting soon . Prescription o Still to be done: . Medication Statement and Medication to be done.  What are we focusing on V3 Composite/Lab, or FHIR Common Order? o Problem is that FHIR needs to tie back to V3 RMIM o Also don’t want to end up with many different resources.

PHER Updates  Two projects related to performance of newborn screening, congenital heart disease screening. They went to first round of balloting. Both look like they will be completed this round.  Working on FHIR resources.  Suggestion to create a V2 IG template on what must, could, cannot be done. o Maybe get some ranking so we can point to good examples o Publishing is dealing with this generally and is thinking about this o HL7 (OO, PHER, HD,??), IHE, CDC (Others? WHO, Infoway, NHS)

Q3 – OO

Agenda  Specimen Specimen  We reviewed the most current Specimen Model in combination with last Thursday’s meeting notes and applied them to the model.  Attached is the resulting model reflecting the current state of discussion/review

D:\Data\SROs\HL7\ Orders-Observations\Specimen\org.hl7.oo.Specimen.information.cim.jpg o  We will continue on our regular Thursday meetings.

Q4 – OO

Agenda  LOI IG Ballot Reconciliation

LOI IG Ballot Reconciliation  Attached please find the dispositions as agreed to for the LOI IG ballot reconciliation.

D:\data\SROs\HL7\ V2\IGs\LOI\V251_IG_SIF_LABORDERS_R1_D1_2013JAN_consolidated.xls o Wednesday

Q1 – OO/II/AP/CG

Agenda  AP/II o Specimen ID project o Integrated Lab Workflow  OO o Specimen Model o FHIR  CG o Questions o Clinical Sequencing DAM o Genetic Testing Report CDA o Family History Implementation Guide

Specimen ID  Working on Specimen ID since Jan 2012 WGM – developing a standard framework to specify interoperable, globally unique identifiers. Developing conceptual model – current state most labs using local identifiers – need transition plan from current state to globally unique identifiers o Need both machine readable and human readable identifiers o Worked with DICOM definition of how they tracked specimens and containers – allows for multiple specimens per container o Been through 2 ballots – almost completed reconciliation – currently an informative ballot o Question : What is the differentiation between specimen and container relative to aliquots. – The reason for leveraging DICOM definition is that is handles derived specimens o Question re globally unique identifier – would it be local, or would you need to query an off lab resource. Assume using a lab identifier that is registered, can be looked up . Many different groups are assigning identifiers to labs – current schemes exist to allow assigning authorities to allocate identifiers. There are challenges with real estate on specimen containers for 2-d barcodes.  What are the next steps? o Want to get to a normative standard – what does that look like going forward?  CLSI call for volunteers 2-d barcodes in Clinical and Anatomic Pathology Labs – see Call for Volunteers  Question – are there any other semantics carried by the identifier? No other semantics are carried, but are not necessarily opaque (de-identification), as may be required in some research use cases. Suggestion to keep the de-identification as a separate step, and recommend that local institutions manage de- identification strategies, and treat this as a subset use case  3 different kinds of barcodes on containers may be there – the identification from container manufacturer, lab automation vendor, LIs assigned specimen identifier

Integrated Lab Workflow Project is to come up with a consistent lab automation workflow for AP and other lab devices that takes into account the bulk data storage of image results from AP, as well as CG – these may be external stores, or local to the LIS – Project is joint between IHE and AP, focused on the work flow around use cases where there is bulk evidence data that must be stored and tracked. Just started working on the development of the project – timeline sometime in 2014 - question from CG about whether they could contribute use case information to the project. Will be planning how they will coordinate the work at the upcoming IHE face to face meeting.

Specimen model update  Update on progress of Specimen model project – working through container and identifier portions of the model – need to harmonize output of AP specimen id project with specimen domain analysis model.  Discussion on the requirement for both an machine readable and a human readable identifier  Would like to have a for-comment ballot for May, but given current progress rate, we may be looking at a September ballot. There is a definite desire for concrete material for contributors to comment on as early as possible  Discuss go forward strategy. The next step – will be to coordinate call to work on harmonizing with the AP specimen id project – Lorraine Constable to coordinate with JD Nolen

FHIR update  OO kicking off this work during this WGM – need to coordinate with work Pharmacy is doing in the FHIR space, as well as AP. AP is interested in beginning FHIR development this cycle – JD Nolen to contact FHIR Management Group

Terminology question Molly has been working with CAP, CDC, cancer registry folks, and the data they are dealing with has lots of biomarkers to track. They need an appropriate terminology approach to code biomarkers. They have been in contact with LOINC, and they are working on potentially adding biomarkers to LOINC – some in NCI thesaurus, but the approach for populating the NCI thesaurus is usually consume external vocabularies. What is the appropriate system to track biomarker codes? The recommendation to get it into LOINC to enable international use of the coded concepts. How much pre- coordination versus post-coordination of codes are required? Ideally want to point to nomenclatures to identify biomarkers. LOINC is most appropriate if you look at biomarkers as a test - need to relate the test with an answer list of the clinically relevant biomarkers. Medgen is a new repository of concepts that are clinically meaningful and will link to additional annotations to external genetic databases. LOINC is a good place to start for the framework, but need additional information, and will still need to code the answer lists. Scope is – what does the cancer registry need – what is clinically meaningful.

Clinical Sequencing DAM  Need Contacts from II and from AP to review material  Balloted as Request for Comment this past cycle. Only about 20 pages the team would welcome review and feedback. Currently high level summary, focused primarily on use cases. They received good comments this cycle. Describes a workflow so that any one connection or step can be associated with standards , Genetic testing Report CDA  Passed and is going to publication Family history implementation guide  Passed ballot and is going to publication Q2 – OO + FHIR

Agenda  Review resources in OO scope  Review ballot comments  Walk through microbiology example  Discuss go forward planning

Resource Review

Grahame provided an introduction to the resources that are in scope of OO – goal is the resources required to support a mobile PHR.

LabReport: Covers the spectrum of what a lab issues. Some reports are pure unstructured text, some purely structured data, many are somewhere on the continuum between structured and unstructured.

The use case is lab to clinical consumer information exchange

Question re service element – equivalent to Diagnostic Sect Code. Needs to be 0..*

DiagnosticTime – specimen collection time vs lab observation time – there are two circumstances where you do not have specimen collection but do have observation time – diagnostic time is the most clinical relevant time.

Report time – represented in the issued element

Discussion – does our scope include secondary use and other broader use cases, or should we focus on the basic use cases involved in communication between a lab and a provider.

Grahame suggesting naming this DiagnosticReport so it can be generalized beyond lab.

Observation: This is general (non-lab) observations. Discussion around whether component observation should recurse

Question about how to handle negation – how to differentiate between “did not observe” and “observe that this is not the case”

Difference between Subject and Record Target – asserted that not in the 80%

Received a ballot comment regarding whether we should use the simpler Observation model in the Laboratory report – needs further discussion

Order REST imposes constraints on the order process – FHIR focused on repository of information. Orders more natural in messaging – need to handle both repository-based and message-based approach to orders.

Order Response Reviewed OrderResponse resource, in particular the codes for the kind of response

Need resources to define DiagnosticOrder, etc

Also discussed List resource – used for Medication List, Observation List, etc. Question about whether you would use this for Order Set – not really what this was defined for.

Device About identifying an instance of a device Question about use of the Universal Device Identifier (GS1 device identifier) that encapsulates the fields in the device encapsulation

Do we need to model the location of a device within a patient?

Ballot Feedback Reviewed ballot reconciliation comments

Microbiology Example Walked through a microbiology example provided by Rob where nested groups may need to be reported – this is not accommodated by the current structure. Rob will send the example to Grahame. Looked at the LabReport resource – we will need to restructure the resource to accommodate the ability to capture a result list or nested result groups

Planning for Next Steps Deferred to Thursday Q1

Q3 – OO

Agenda  Lab Model Ballot Reconciliation

Lab Model Ballot Reconciliation  See attached spreadsheet for Lab Model DAM Ballot Reconciliation:

D:\data\SROs\HL7\ V3\2013-01\V3DAM_LABORD_R1_D1_2013JAN_Consolidated.xls o

Q4 – OO

Agenda  Table 0078  Lab Order DAM Ballot Reconciliation

Table 0078  Ken did not have further information, so need to move this to conference calls.  Need to understand why certain terms were deprecated before we can proceed.  Will target mid-February to put this back on the OO agenda.

Lab Order DAM Ballot Reconciliation  See the spreadsheet referenced in Wednesday, Q3, Lab Model Ballot Reconciliation. Thursday

Q1 – OO

Agenda  FHIR Ballot Reconciliation  LOI IG Ballot Reconciliation

FHIR Ballot Reconciliation  Reviewed Observation resource – Grahame discussed Device resource with the devices group, noted that we need a way to track that an observation from a device might be invalid – will add a field to the Observation resource.

 We reviewed the OO specific ballot items from FHIR. The dispositions are documented attached.

Comments-FHIR_R1 _O2_2013JAN.xls o  Keith Boone requested in-person reconciliation, so all the items with dispositions related to Keith’s comments require further follow-up whether they are satisfactory, or whether we need to schedule time during an upcoming OO call as Keith was not able to participate in today’s session.

FHIR Next Steps  Discussion about resource planning for ongoing priorities for next steps regarding FHIR, LabOrder, specimen, etc. Will need to try to move all of them forward – but may need to prioritize FHIR based on resource constraints.  Will send out a doodle poll to set up calls to work on FHIR

LOI IG Ballot Reconciliation  See ballot reconciliation under Tuesday, Q4, LOI IG Ballot Reconciliation.

Q2 – OO/CDS

Agenda

 Order sets o Health eDecisions  Clinical Orders  OO / Patient Care / CDS Joint Meeting Thursday Q1 or Q2

Order Sets

 Working on draft standards for order sets as a structured document.  Not to instantiate an order, but only to define valid orders within sets as knowledge.  DSTU published around September 2012  Over last 6 months Health eDecisions initiated to establish a generic knowledge document including order sets, but not just order sets.  Just balloted that knowledge document in January.  Unclear whether the original order set DSTU (September 2012) will ever be adopted, rather using the Health eDecisions document. At least for US.  Health eDecision o Use Case 1 – knowledge document use case . Order Sets . Clinical Documentation . Event conditions o Suggest to review V2 Chapter 8 and eDOS IG to determine/address any potential conflicts. While not intended to be in sync as V2 does more than order sets, still helpful to check on potential conflicts as both are on their way to a future MU stage.

Order Service

 While original intent to develop for VA specifically and then go to HL7, agreed to incorporate efforts with HL7 earlier.  Three use cases o Event Subscription and Notification Service o User Communication Service o Order Placement Service  Interested in HL7 workgroups to be sponsor or co-sponsor o OMG stepped up to Event Subscription and Notification Service o OO and CDS asked for Order Placement Service  OO working on Composite/Lab Order with first level service description  Suggestion that OO sponsors and CDS, SOA, and Rx co-sponsor.  Emory is project lead, Lorraine is OO co-chair on point, Ken is reaching out to Rx.  Will work on project statement. No rush for May WGM.  Will this solve the problem that providers will actually use common terminology.  What drives parties to actually take on and become consistent. HL7 can only go so far as a voluntary standards organization. Other organizations/initiatives can further this through contracting, regulatory, or other incentives to encourage take on.  Active group in S&I talking on Lab test coding to harmonize/synchronize. The challenge is in the panels, but did not get into that yet. Under Bob Dieterle.  Similar work going in Health eDecisions on terminology.  Is there overlap between use case 2 and some of the work discussed today.  Thursday Q1, Joint OO/CDS/Pt Care.

Q3 – CS/OO

Agenda

 Clinical Statement

Ballot Reconciliation

 See the spreadsheet attached for ballot reconciliation dispositions

V3_CS_R1_U4_2013 JAN_consolidated.xls o  Motion to move the document into a Normative ballot in the May 2013 ballot cycle and submit the NIB accordingly. Lorraine Constable, Ken McCaslin o 7 in favor, 1 abstain; 0 against  We will list Patient Care formally as a joint workgroup for Thursday Q3/Q4  Tooling is working on a tool for pattern/template validation. Request CS to sponsor. o Motion for CS to become a co-sponsor of a tooling project to enable validation of models against such patterns as clinical statement (and other V3 artifacts). Hans, Lorraine . Against: 0; Abstain: 0; In Favor: 8 Friday

Q1 – OO

Agenda

 V2.9 Proposal  WGM Questionaire  Other

V2.9 Proposals

 735 – INV in OUL o We identified two alternatives. Motion to present both alternatives to IHE Lab domain team with the suggestion to accept Alternative Two. If IHE Lab accepts that, we will move that into V2.9 ballot cycle (once it starts). Otherwise we will make a final decision in a subsequent OO meeting. Scott Robertson, Dmytro Rud. . Against: 0; Abstain: 0; In Favor: 5

WGM Survey Input

 Quorum, Meeting objectives – We had quorum all meetings, except Monday Q3.  Achieved V2.8, FHIR, Nutrition ballot reconciliation.  Good progress on LOI IG, Comp/Lab DAM ballot reconciliations.  Progressed Specimen modeling and harmonized projects with Rx, CDS, Pt Care, and PHER.  Weather was not as advertised. Difficult to get coffee after lunch. Rooms, AV was good. Internet was adequate to good.

V2.8 Ballot Reconciliation

 We started to look at the remaining ballot item for V2.8, but concluded that Hans needs to do further prep work to re-work the message structure below to reflect what was intended. This will be reviewed at an upcoming OO meeting for final disposition.

OMQ^O42^OMQ_O42: General Order Message with Document Payload

Segments Description Status Chapter MSH Message Header 2

[{SFT}] Software 2

[ UAC ] User Authentication Credential 2

[{NTE}] Notes and Comments (for Header) 2

[ --- PATIENT begin

PID Patient Identification 3

[PD1] Additional Demographics 3

[{PRT}] Participation (for Patient) 7 Segments Description Status Chapter [{NTE}] Notes and Comments (for Patient ID) 2

[{NK1}] Next of Kin/Associated Parties 3

[{ARV}] Access Restrictions 3

[ --- PATIENT_VISIT begin

PV1 Patient Visit 3

[ PV2 ] Patient Visit- Additional Info 3

[{PRT}] Participation (for Patient Visit) 7

] --- PATIENT_VISIT end

[{ --- INSURANCE begin

IN1 Insurance 6

[ IN2 ] Insurance Additional Information 6

[ IN3 ] Insurance Additional Information, 6 Certification

}] --- INSURANCE end

[ GT1 ] Guarantor 6

[{AL1}] Allergy Information 3

] --- PATIENT end

{ --- ORDER begin

ORC Common Order 4

[{PRT}] Participation (for Common Order) 7

OBX Observation containing document 7

[{PRT}] Participation 7

TXA Transcription Document Header 9

[ CTD ] Contact Data 11

[{DG1}] Diagnosis 6

[{ ---OBSERVATION begin

OBX Observation containing document 7

[TXA] Transcription Document Header 9

[{NTE}] Notes and comments 2

}] ---OBSERVATION end

--- OBSERVATION begin Segments Description Status Chapter OBX Observation/Result 7

[{PRT}] Participation (for Observation) 7

[{NTE}] Notes and Comments (for Results) 2

}] --- OBSERVATION end

[{ --- PRIOR_RESULT begin

[ --- PATIENT_PRIOR begin

PID Patient Identification – previous result 3

[PD1] Additional Demographics – previous result 3

[{PRT}] Participation (for Patient Prior) 7

[{ARV}] Access Restrictions 3

] --- PATIENT_PRIOR end

[ --- PATIENT_VISIT_PRIOR begin

PV1 Patient Visit – previous result 3

[ PV2 ] Patient Visit Add. Info – previous result 3

[{PRT}] Participation (for Patient Visit Prior) 7

] --- PATIENT_VISIT_PRIOR end

[{AL1}] Allergy Information - previous result 3

{ --- ORDER_PRIOR begin

ORC Common Order - previous result 4

OBR Order Detail - previous result 4

[{ --- TIMING_PRIOR begin

TQ1 Timing/Quantity 4

[{TQ2}] Timing/Quantity Order Sequence 4

}] --- TIMING_PRIOR end

[{NTE}] Notes and Comments - previous result 2

[{PRT}] Participation (for Order Prior) - 7 previous result

[ CTD ] Contact Data - previous result 10

{ --- OBSERVATION_PRIOR begin

OBX Observation/Result - previous result 7

[{PRT}] Participation (for Oservation Prior) 7

[{NTE}] Notes and Comments - previous result 2

} --- OBSERVATION_PRIOR end

} --- ORDER_PRIOR end

}] --- PRIOR_RESULT end

[{FT1}] Financial Transaction 6

[{CTI}] Clinical Trial Identification 7 Segments Description Status Chapter [ BLG ] Billing Segment 4

} --- ORDER end