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Orders & Observations Phoenix Working Group Meeting May 2008 Meeting Minutes
Transcript of Attendee - Health Level Seven International 2… · Web viewAgreed to remove the word "unique"....
Orders & Observations
Phoenix Working Group Meeting
May 2008
Meeting Minutes
Table of Contents
ATTENDEES...............................................................................................................................................................3
MONDAY Q1/Q2 – OO – V2.7..................................................................................................................................4
MONDAY Q3...............................................................................................................................................................5
Monday Q4 – OO/CDS/Patient Care.............................................................................................................................6
AttendeesAttendee Company/E-Mail Mo
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Rita Altamore [email protected] √Kay Avant [email protected] √Fred Behlen [email protected] √Steve Bentley [email protected] √ √Scott Bolte [email protected] √Keith Boone [email protected] √Louise Brown [email protected]
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Hans Buitendijk [email protected] √Jim Case [email protected] √ √ √ √Edward Cheetham [email protected] √Todd Cooper [email protected] √Laurecia Daiby-Evans
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Robert Dunlop [email protected] √Floyd Eisenberg [email protected] √Isobel Frean [email protected] √Colin Fy Garstka [email protected] √Patty Garvey [email protected] √Grant Gillis [email protected] √Hugh Glover Hugh_glover@bluewaveinform
atics.co.uk√
William Goossen [email protected] √ √Bob Greenes [email protected] √Rick Haddorff [email protected] √Rob Hallowell [email protected] √Peter Haug [email protected] √Monica Harry [email protected] √ √John Hatem [email protected] √ √Peter Haug [email protected] √Rob Hausam [email protected] √ √ √Peter Hendler [email protected] √Stan Huff [email protected] √Martin Hurrell [email protected] √Marta Jaremek [email protected] √Mike Jolley [email protected] √Crystal Kallen [email protected] √Helmut König [email protected] √Alexander Kraus [email protected] Kreisler Austin.kreisler@[email protected] √ √ √ √ √Thomson Kuhn [email protected] √Ken Lauver [email protected] √Joann Larson [email protected] √ √ √Zhijing Lin [email protected] √Carolyn Logan Carolyn.b.logan@questdiagnos
tics.com√
Dragana Lojpur [email protected] √Patrick Loyd [email protected]
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Attendee Company/E-Mail Mon
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Greg Marinkovich [email protected]
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Michael Martin [email protected] √ √Susan Matney [email protected] √Ken McCaslin Kenneth.h.mccaslin@questdiag
nostics.com√ √
Barbara McKinnon [email protected] √Scott McKinnon [email protected] McKnight [email protected]
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Rob McClure [email protected] √Gary Meyer [email protected]
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Terri Monk [email protected] √Andrew McIntyre [email protected]
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Craig Newman [email protected] √ √ √ √Thomas Norgall [email protected] √Frank Oemig [email protected] √Armando Oliva [email protected] √Fal Patel Falguni.b.patel@questdiagnosti
cs.com√ √
Diana Perez-Lopez
[email protected] √ √ √ √ √ √ √ √
Cecile Pistre [email protected]
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Philip Pochon [email protected] √ √Ali Rashidee [email protected] √Melvin Reynolds [email protected] √Jeff Rinda [email protected] √John Roberts [email protected] √Scott Robertson [email protected] √Craig Robinson [email protected] √ √Jason Rock [email protected] √Gunther Schadow [email protected]
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Paul Schluter [email protected] √Amnon Shabo [email protected] √Rik Smithies [email protected] √Harry Solomon [email protected] √ √ √Lise Stevens [email protected] √Walter Sujansky [email protected] √ √ √Michael Tan [email protected] √Greg Thomas [email protected] √ √ √ √ √ √ √ √Ian Townend [email protected] √Mollie Ullman-Cullere
Mead Walker [email protected] √Tim Williams [email protected] √Jan Wittenber [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], and [email protected].
Monday Q1/Q2 – OO – V2.7
Reviewed V2.7 ballot feedback per attached spreadsheet.
Motion to defer all A-T items to editors. Patrick, Austin. Against: 0, Abstain: 0; In Favor: 7
Monday Q3
No quorum. Reschedule Observation Request v3 ballot reconciliation to Wed Q3.
Monday Q4 – OO/CDS/Patient Care
DSS
Presenter: Robert DunlopProvide update vMR (virtual medical record) – soliciting input from PC and OOScope: to create a vMR data model recommendation and implmenetation guide
Target: level 3 clinical decision support (computer interpretable guidelines)
Get presentation from Robert Dunlop (email: [email protected])
Frank O. showed Germany project Proj-EPA with similar scope and showed some constructs that project is using which might be helpful to leverage. Robert/Barbara McKinnon to contact Frank
Patient Care
Presenter: William GoossenDetailed Clinical Models – Assessments
Get all presentations from William G. (email: [email protected])
Update on current progress - Assessments
New project scope statement – Detailed Clinical Models Release 1Next version of GELLO is a separate project under CDS
Patrick – Check w/David Hamill – HITSP???? (on project scope statement)
Clinical Trials
Presentation from Jason Rock – (email: [email protected])
RCRIM and appropriate SD has approved the project scope statement for this. CDS is looking to solicit input from other groups. A few work groups to approach to participate were brought up during discussion.
Tuesday Q1 – OO/Lab/Rx – Dynamic Model
1. ARB created dynamic model frameworka. Need to ensure ARB harvests work done by OO/LAB/RX.b. Instantiation of actual model (OO/LAB/RX) vs generality of an abstract model (SOA/ARB). We
need to balance both.c. Has format been defined? Not yet. Should be a deliverable.d. Add OO/LAB/RX to committees to be consulted.e. Use order fulfillment cycle (order, promise, event) as a good use case as it represent one of the more
complicated use cases.f. Whether HL7, SOAP, EBXML, the dynamic model should hold. A requirement should be that the
dynamic model should tie into the state machine and remain fully technology independent.g. Need to be clear that we talk both about sender and receiver responsibilities.h. Need to use HL7 lingo.
2. What can we do in the mean time:a. Patrick and Louise volunteered to be the OO bulldog. We want to make sure we’re participating in
the out-of-cycle.b. Create a reasonably comprehensive example as a use case. Lab storyboard and Rx state machine
examples should be starting point.3. Do we have a process to apply the framework and constraints?4. Feedback on Visio
a. Consider removing dotted lines as they representb. Need to find a way to highlight/document dependencies more explicitely. Transactions are very
clear, interactions are more implied then explicit.c.
5. Other requirements.a. Need to manage state machinesb. Interaction between acts of different moods.c. Create complex interaction patterns.d. We need to be able to string building blocks of smaller patterns into larger, more complex
interactions supporting a business need. There can be many permutations of that.e. Allow different conformance statements to different pattern combinations.
Get various visios and charts – John, Louise, Patrick, Hans to pull document together.Invite ARB to this session.
SAMPLE – Lab InteractionComplex Lab Order w/ RR w/ Mult Msgs (POLB_SN122000)
Presentation
Eve Everywoman, a 27-year-old female, presents at Good Health Hospital Outpatient Clinic and is seen by Dr. Patricia Primary. Eve reports extreme thirst, fatigue, and recent unexplained weight loss. She also reports having a family history of diabetes. Dr. Patricia Primary wants to rule out diabetes mellitus by performing a GTT2HR.
Scheduling
The GTT2HR needs to be scheduled with the laboratory. At this laboratory, the procedure is scheduled before an order can be placed. The patient is informed to complete an overnight fast prior to the test. Scheduling is out of scope for this storyboard.
Activate Order
Dr. Primary orders a GTT2HR test. Nurse Nightingale enters the order for the scheduled time. The order fulfillment request message is sent from the ordering system to the laboratory system (POLB_IN111100).
GTT2HR protocol at GHH Laboratory is as follows:
← Fasting Glucose ← Glucola Administration
← Glucose 1 Hour
← Glucose 2 Hour
Dr. Primary expects that through placing this one order, all of the above will be done.
Order Confirm Response
The laboratory system receives the order fulfillment request message and determines that it meets the laboratory system's requirements for confirming an order. The laboratory system responds with an order confirm response message (POLB_IN121000). The laboratory system will hold the order until the patient arrives.
Patient Registration
Eve arrives at the GHH laboratory the next day having fasted since midnight. Christopher Clerk finds the order for the GTT2HR. The system assigns the accession number, and prints specimen labels. She notifies the phlebotomist to collect the fasting specimen.
Activate Laboratory Promise and Collect Fasting Glucose Specimen
Bill Beaker escorts Eve to the phlebotomy room, explains the procedure, confirms that she is fasting, and collects the fasting glucose specimen at 7am. Bill labels the specimen with a preprinted label. The collection date/time and specimen type are entered into the laboratory system. The first specimen collected is marked to be run stat. A promise for the GTT2HR is sent back to the ordering system (POLB_IN122100).
Promise Confirm Response
The ordering system receives the promise message and determines it meets the ordering system's requirements for updating its order with the promise. The ordering system responds with an promise confirm response message (POLB_IN112000).
Fasting Glucose Final Result
Bill takes the specimen to the laboratory for processing. He tests the specimen, reviews the result and then releases it. The laboratory system sends the result to both the ordering system and the result reporting system (POLB_IN124100). Note that although the fasting glucose result is final, the promise for the GTT2HR is still in progress.
Chemistry Observation/Test Name
Result Value/Flag Units Reference
RangeTime Observation
Performed
Glucose Fasting 80 mg/dL 65-99 0715
Fasting Glucose Result Confirm Response
The ordering system and the result reporting system both confirm the fasting glucose result and responds to the laboratory system with a message that the result message has been confirmed (POLB_IN134000).
The Challenge
The fasting glucose result reported at 7:15am is within acceptable protocol range for Bill Beaker to proceed. He gives Eve a challenge of glucola-75 gm to drink at 7:20am, which she finishes at 7:30am. Bill collects and labels the remaining specimens according to the schedule listed below:
← Glucose 1-Hour test at 8:30am← Glucose 2-Hour test at 9:30am
Bill records the date and time of each specimen collection into the laboratory system and delivers the specimens for testing.
Result Processing
Bill performs the tests, reviews the results and determines whether or not they are critical or panic values that would require immediate physician notification (none of them are).
Final Results
Upon reviewing the results, he releases them for final reporting. The laboratory system then generates a result message for the remaining results that is sent to both the ordering system and the result reporting system (POLB_IN124200).
Chemistry Observation/Test Name
Result Value/Flag Units Reference
RangeTime Observation
Performed
Glucose 1 Hour 120 mg/dL <130 1100
Glucose 2 Hour 114 mg/dL <140 1100
Result Confirm Response
The result message is acceptable to the result reporting system so it responds with a message indicating that the results have been confirmed (POLB_IN134000). The ordering system confirms the result complete message and marks its order as "Complete". A single result/confirm response message pair referring to both challenge specimens is exchanged between the laboratory system and the result reporting system. The ordering system also sends an email to Dr. Patricia Primary notifying her that results are available.
Conclusion
Dr. Primary reviews and rules out diabetes mellitus and signs off the results on the result reporting system.
Tuesday Q2 – OO – ELINCS Implementation Guide
The implementation guide passed the review ballot.
Based on the rules, we do not require a new ballot round to address resolution of negative ballots. In fact, none of the ballot feedback (positive or negative) needs to be addressed before publishing. So by default, the document can be published as-is. However, as part of a review and resolution of the ballot feedback, the workgroup may accept changes that as a consequence of the current state do not require a next ballot round.
We considered the following follow-up steps:
All typos and technical corrections will be applied by the editor Do not address the comments that have been addressed in the past. For the remainder of the feedback, the project team attempts to resolve them.
o If unanimous consensus is reached without extensive discussion, the resolution is included in the document.
o If no consensus can be reached, the topic is put on the list of topics for a next version. The document and resolution are presented back to the OO workgroup for final confirmation. The document is published Plans will be created for a next version (based on V2.6, V2.7, or still on V2.5.1 – TBD)
We agreed to the following steps (motion: Patrick, Bill)
All typos and technical corrections will be applied by the editor Do not address the comments that have been addressed in the past. Everything else is moved to a future version. The document and resolution are presented back to the OO workgroup for submission to Publishing The document is published Plans will be created for a next version (based on V2.6, V2.7, or still on V2.5.1 – TBD)
Against: 0; Abstain: 1; In Favor: 8
We may register the document with ANSI as a technical report. Motion to recommend to TSC to request ANSI registration as a technical report. Bill, Ken.
Against: 0; Abstain: 2; In Favor: 7
Next meeting re-review project charter and the Order project.Should review all OO project charters during upcoming conference calls.
Need to update the IP statements to reflect completion of the effort. Patrick, Walter, and Bill to review the contract. Bill to get the letter from HL7 to California Healthcare Foundation.
Tuesday Q3 - OO/Patient Safety/Rx/PHER – Supply Approach
HL7 needs to identify a way to model this. Need to look at other areas to incorporate, but cannot just reference them. X12 costs money, Edifact may be usable.
http://www.epcglobalinc.org/standards/pedigree/
SPL reasonable starting point, but requires some adjustments to address the data requirements. Mead and Gunther will create first cut.
Wednesday Q1 – OO/Dev – Blood Infusion
Blood InfusionOpen issues:
Where to put the identifier of the device?o ORC – Entering Device Not viableo OBX – As a parametero MSH – Receiving Network Address Not viableo RXR – New Proposalo Motion: Use OBX to start, Administration Device Identifier (EI, Optional, not repeat) to RXR at
earliest opportunity, Jeff Rinda, Todd. Against: 0; Abstain: 0; In Favor: 13 Where to put the observation on the response?
o Don’t use response message for updated parameters.o Consider using ORC.1 control code of XX with RGV.o ORC.5 Status code can be whatever makes sense.
Profile identifiers assignment process is not clear. Will be checked with Iona. Z-events to official triggers requires proposal.
V3 Mapping Rename “HL7 V3 Medical Device Semantic Profile” to “HL7 V3 Medical Device Semantice Modal (D-
MIM)”. Rename “HL7 V3 Message Profile(s)” to “HL7 V3 Messages”
Wednesday Q2 – OO – BTO
We did get input on attribute level descriptions and approach.Challenged with time of leadership to help drive the progress and coordination across the ocean.Ready again for next ballot round over the summer.Request to open project to focus on Product (not the same as Specimen).Need resources. One new interested party in Europe.
Wednesday Q3 – OO – V3/V2.7 Ballot ReconciliationSee spreadsheets.
Wednesday Q4 – OO/II – Orders Update
o January reconciliation done on all but one (Common Obsv) DICOM-SR/CDA IG
Transformation Guide reviewed with DICOM WG6 and released for public comments. CDA Diagnostic Imaging Report IG (if DICOM is not involved) – got ballot feedback from review.
Next ballot in September may not be necessary as this round the IG may have passed.
Thursday Q1 – OO/Genomics
Structuring Clinical Genetic test Results Update Extended in V2 messages Target first live in September 2008 at InterMountain.
o Lower volume to PHS initiallyo Higher volume to ARUP targeted for later.
CHW also interested in implementing this message. Fully LOINC qualified Working with HITSP to enhance awareness. HITSP is interested. Reviewed presentation. Also vocabularies mapped back to RCRIM and then implementation guides will be updated. Need to address the uniqueness of OBR.3 A recommendation was made to ensure that it is unique while
using Parent (OBR.29) to link the related OBR/OBX groups. o This is posing a bit of a challenge given what systems can/cannot handle. o HITSP is driving towards uniqueness in any implementation guides they develop.o ELINCS has a guide that recognizes this challenge based on V2.5.1, but as of V2.7 we are removing
the attributes that enable this so there is ample transition time from V2.5.1 to V2.7 use.
Specimen V2 Tables being consolidated that will enable putting V2 vocabulary on a independent update cycle. - Joann Need follow-up with TSC to get V2 process defined (who owns decisions, how processed, etc.) - Hans In V3 we can already follow-up within Vocabulary. Need to re-enforce need that the process needs to be
more efficient. – Facilitators + Hans Genomics will also look at external sources that could be used.
Specimen HandlingWould like to coordinate with Lab WG.Specimen Process Step is already in Lab that can be looked at. Does not have implementation guide yet.Need to consider putting this on the list as a joint project between Genomics / Lab.Biospecimen tracking (Univ of Utah) may be able to contribute with story boards. Susan MatneyHow does it overlap with CA Tissue? Maybe not initially, but in the future.
AdministriviaWe reviewed various project and organizational topics. We updated the project tool with most current project statements.
Orders & Observationo Projects:
BTO Order Pattern Observation Request Composite Order CMETs x, y, z Dynamic Model Take-On
o Question – Project or Work Group:
Healthcare Devices II Clin Genomics
Pharmacyo Projects:
20 odd Laboratory
o Projects: Result Topic Specimen Process Step Unofficial CMET
Suggestion for Clinical Statement Project to be owned by Orders. Other Workgroups are resources We schedule joint sessions to review To be discussed with Clinical Statement
Care Statement Project to be owned by Patient Care
Project Statement Review:
Order Domain – Phase IIn this project, the Orders & Observations Work Group will focus on development of a message model to:
establish a common order pattern that can be used as the starting point for any general and specialized order domains, e.g., composite order, lab order, prescription, etc.
create a Composite Order model to enable communication of various order types within one message, such as observation orders, procedure orders, patient supply orders, and other types of orders.
The scope of this project includes development of all the modeling artifacts necessary to support the overall pattern and these messages. This topic covers all interactions related to requesting single or combinations of healthcare services.
The Composite Order topic includes the ability to order multiple basic healthcare services in one message. The initial scope of this project includes:
lab services diagnostic imaging services pharmacy services
Future projects will cover expansion into:
blood supplies tissue and organs procedures treatment (physical therapy, etc.) equipment/devices patient supplies
Observation Domain
In this project, the Orders & Observations Work Group will focus on the development of a Common Observation domain model and an Observation Request model to support communication of general observation orders that are not covered by Laboratory and Diagnostic Imaging orders.
Orders & Observations CMETs – Phase IIn this project, the Orders & Observations Work Group will focus on development of CMETs in support of various domains to enable easy inclusion of orders and observations concepts that should be used consistently across those domains.
Supporting Clinical Information (Universal/Minimal) Observation General (Universal) Observation Diagnosis (Universal/Minimal) Observation Intolerance (Universal) Annotation (Universal)
Clinical Statement
o Harmonize Clin Statement and Medication/Prescription – Move to September 2008. Do Product work first.
o CMETs Q3 - Oral Health ownership: who is it? Looks like we need to chat with FM as th
Should we have a quality control process with Clinical Statement that CMETs should go through? The Work Group that owns Clinical Statement should do so, using a process akin to the Change Request.
Q3 – Detailed Clinical Model – sponsorship Various examples refinements and further expressed Clinical Statements. This could over time into many
variations. Need to come up with project definition on how to manage this. Properly using TermInfo. Similar to Oral Health, we need a place to harmonize. Conceptually CMETs, Templates, Archetypes in this space are the same in that they help focus and tailor
Clinical Statement to specific use cases. Clinical Statement would own/sponsor the project to define the process and deliverables that then can be used
by everybody else. Challenge with balancing need to control with ability to develop CMETs/etc. where work groups know how to
do it. Should focus on assisting projects who run into challenges or need start-up.o Q3 - Change Request Review
74, 75, 76 need to be updated with Jan 2008 votes and moved to Dispositioned Requests.o Q3 - DSTU Ballot to Normative
Current DSTU runs out December We therefore need to decide whether to go for another DSTU (one more time for 2 years) or Normative Good incentive for Clinical Model. What is really the value of a Pattern being Normative? Should it be Informative?
Similar to data types, terminfo, templates, RIM? Also never implemented on its own, but it’s normative. Constraining and process keeps it consistent and that is also achieved in work group ballots. Many examples where Clin Statement is plugged in without proper constraints. Being DSTU did not prevent
this. If normative then how do we deal with intending to have most current work reflect most current thinking in Clin
Statement? Normative seems to support better syncing on one interpretation and static for a period of time. Informative seems to support more dynamic. Normative can better support conformance statements.
Care Provision DMIM includes Clin Statement. CDA includes Clin Statement as well. However, if put in material should be balloted as CMET or part of domain.
o Q3 - Process on how to manage extensions and documentation thereof If Work Group, could do every x meetings review/alignment. If we are not normative then focus on process. Do we really care? May be good practice to care, but how do we deal with that? Can we use MIF DIF tool? Probably not. Create opportunity to have people review with Clinical Statement how they have applied or should apply as open
invitation. Motion to drive practices once the work group has been established.
o Q3/4 - Clin Statement + Clin Genomics Postponed.
o CMETs – Q4 - Update on CMET activity
Publishing requires detailed attribute descriptions before normative ballot round. We don’t have those in place, so we need to add them.
Need to do that through Clinical Statement and then into CMETs. How do we get this done? Requires substantial resources.
So can’t move forward with CMETs until this is done. Rather then using current tools, need to use direct XML editor. Still substantial since we have to write different
considerations in a class. Do we focus on general description with or without specific use cases? Could we distribute the load based on close affinity of workgroups? Could we use template information? But not documented, duplication of effort, etc. Rik volunteers to do a prototype. We can then review how it works, refine and identify next steps. Rik and
Keith to chat about potential to use HTML to create a place where we can edit easily. 1-2 months out to review.
This implies that we have to ask for extension DSTU to give another 2 years of time (Isobel). In general, we need to check with Charlie on latest updates. Isobel
o Q4 - Incorporation of Clin Statements into CDA (2010) For R3 idea is to put latest Clinical Statement in place (possibly a CMET). Apparently also an idea to stub in RIM, but no consensus on that. CDA looking into general + template vs. tight definition.
o Meeting Schedule – Workgroup – Project Ownership - etc. Project vs Work Group vs Multiple Workgroups
Noticing expansion of scope, projects, ongoing, Could continue with 2 quarters where multiple Work Groups are hosted to avoid space/resource conflicts. Formalizes ownership more clearly. Motion: Current Clinical Statement project to be transformed to a Work Group (per rational above) and
continues to operate as the project has over the last number of years (joint sessions, dedicated quarters). William, Rita Against: 0; Abstain: 0; In Favor: 17.Project Leads will prep documentation and co-chair elections will be held once approved by the TSC. Proposed Steering Division is Structured and Semantic Design.
o Q4 - Common Observation Jan 2008 Ballot Reconciliation Did not get to this.
