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

Attendees

Attendee / Company/E-Mail / Mon AM / Mon PM / Tue AM / Tue PM / Wed AM / Wed PM / Thu AM / Thu PM / Fri /
Rita Altamore / / √
Kay Avant / / √
Fred Behlen / / √
Steve Bentley / / √ / √
Scott Bolte / / √
Keith Boone / / √
Louise Brown / / √ / √
Hans Buitendijk / / √
Jim Case / / √ / √ / √ / √
Edward Cheetham / / √
Todd Cooper / / √
Laurecia Daiby-Evans / / √ / √
Robert Dunlop / / √
Floyd Eisenberg / / √
Isobel Frean / / √
Colin Fy Garstka / / √
Patty Garvey / / √
Grant Gillis / / √
Hugh Glover / / √
William Goossen / / √ / √
Bob Greenes / / √
Rick Haddorff / / √
Rob Hallowell / / √
Peter Haug / / √
Monica Harry / / √ / √
John Hatem / / √ / √
Peter Haug / / √
Rob Hausam / / √ / √ / √
Peter Hendler / / √
Stan Huff / / √
Martin Hurrell / / √
Marta Jaremek / / √
Mike Jolley / / √
Crystal Kallen / / √
Helmut König / / √
Alexander Kraus /
Austin Kreisler / Austin.kreisler@ / √ / √ / √ / √ / √
Thomson Kuhn / / √
Ken Lauver / / √
Joann Larson / / √ / √ / √
Zhijing Lin / / √
Carolyn Logan / / √
Dragana Lojpur / / √
Patrick Loyd / / √ / √ / √ / √ / √ / √ / √ / √
Greg Marinkovich / / √
Michael Martin / / √ / √
Susan Matney / / √
Ken McCaslin / / √ / √
Barbara McKinnon / / √
Scott McKinnon /
Larry McKnight / / √ / √
Rob McClure / / √
Gary Meyer / / √ / √
Terri Monk / / √
Andrew McIntyre / / √
Craig Newman / / √ / √ / √ / √
Thomas Norgall / / √
Frank Oemig / / √
Armando Oliva / / √
Fal Patel / / √ / √
Diana Perez-Lopez / / √ / √ / √ / √ / √ / √ / √ / √
Cecile Pistre / / √
Philip Pochon / / √ / √
Ali Rashidee / / √
Melvin Reynolds / / √
Jeff Rinda / / √
John Roberts / / √
Scott Robertson / / √
Craig Robinson / / √ / √
Jason Rock / / √
Gunther Schadow / / √ / √ / √ / √
Paul Schluter / / √
Amnon Shabo / / √
Rik Smithies / / √
Harry Solomon / / √ / √ / √
Lise Stevens / / √
Walter Sujansky / / √ / √ / √
Michael Tan / / √
Greg Thomas / / √ / √ / √ / √ / √ / √ / √ / √
Ian Townend / / √
Mollie Ullman-Cullere / / √
Mead Walker / / √
Tim Williams / / √
Jan Wittenber / / √

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

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 Dunlop

Provide update vMR (virtual medical record) – soliciting input from PC and OO

Scope: 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: )

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 Goossen

Detailed Clinical Models – Assessments

Get all presentations from William G. (email: )

Update on current progress - Assessments

New project scope statement – Detailed Clinical Models Release 1

Next 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: )

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 framework
  2. Need to ensure ARB harvests work done by OO/LAB/RX.
  3. Instantiation of actual model (OO/LAB/RX) vs generality of an abstract model (SOA/ARB). We need to balance both.
  4. Has format been defined? Not yet. Should be a deliverable.
  5. Add OO/LAB/RX to committees to be consulted.
  6. Use order fulfillment cycle (order, promise, event) as a good use case as it represent one of the more complicated use cases.
  7. 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.
  8. Need to be clear that we talk both about sender and receiver responsibilities.
  9. Need to use HL7 lingo.
  10. What can we do in the mean time:
  11. Patrick and Louise volunteered to be the OO bulldog. We want to make sure we’re participating in the out-of-cycle.
  12. Create a reasonably comprehensive example as a use case. Lab storyboard and Rx state machine examples should be starting point.
  13. Do we have a process to apply the framework and constraints?
  14. Feedback on Visio
  15. Consider removing dotted lines as they represent
  16. Need to find a way to highlight/document dependencies more explicitely. Transactions are very clear, interactions are more implied then explicit.
  17. Other requirements.
  18. Need to manage state machines
  19. Interaction between acts of different moods.
  20. Create complex interaction patterns.
  21. 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.
  22. 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 Interaction

Complex 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 Range / Time 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 Range / Time 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.