Orders & Observations
MayJanuary Working Group Meeting
MayJanuary 1119 - 1423, 2015
Meeting Minutes
Table of Contents
Attendees 4
Monday 5
Q3 – OO 5
Introductions 5
Co-Chair Elections Update 5
Interim Co-Chair 5
Agenda Review 5
FHIR 5
Q4 – OO 7
Agenda 7
FHIR Ballot Reconciliation 7
Tuesday 9
Q1 OO 9
Agenda 9
V2.8.2 Ballot Reconciliation 9
Q2 - OO, RCRIM, Rx. PHER, Devices 11
Agenda: 11
CPM/SPL 11
UDI 11
FHIR 11
Q3 – OO 11
Agenda 11
Nutrition Order Ballot Reconciliation 12
Nutrition statement to deal with goal etc 12
Update on order service: 13
Q4 – OO 14
Agenda 14
V2.8.2 ballot reconciliation 14
Wednesday 16
Q1 16
Agenda 16
V2.8.2 Ballot Reconcilation 16
V2.9/10 proposals: 16
Q2 – OO, II, CG, BRIDG, CIC 17
Agenda 17
BRIDG update: 17
FHIR specimen resource 18
CG update: 19
Q3 – OO 20
Q4 – OO 20
Test case review: 21
Verb review: 22
Error handling discussion: 22
Thursday 24
Q1 – OO, Pt Care 24
Agenda 24
PC Update 24
Q2 – OO 26
Agenda 26
Timeline and Resources 26
FHIR Ballot Reconciliation 27
Q3 – OO, CS 30
Attendees: 30
Agenda: 30
Pastoral Care PSS: 30
CS PSS 31
CSS NIB 31
V2.8.2 ballot 31
Project Insight 32
Q4 – OO 32
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 /Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 /
Aassuo, Ogrind / / √
Alterovitz, Gil / / √
Archambault, Ron / / √
Ayres, Elaine / / √ / √
Brodsky, Victor / / √
Buitendijk, Hans / / √ / √ / √ / √ / √ / √ / √ / √ / √
Constable, Lorraine / / √ / √ / √ / √ / √ / √ / √ / √
Courville, Chris / / √ / √
Dickinson, Gary / / √ / √
Felder, Cornelia / / √ / √
Fry, Emory / / √
Glover, Hugh / / √
Grieve, Grahame / / √ / √
Haas, Eric / / √ / √ / √ / √ / √ / √ / √ / √
Hastek, Smita / / √
Hausam, Rob / / √ / √
Heckmann, Simone / / √
Hirai, Masaaki / / √
Houston, Paul / / √
Joerg, Werner / / √
Kiser, John / / √
Knapp, Paul / / √
Lomayesva, Paul / / √
Loyd, Patrick / / √ / √ / √ / √ / √ / √ / √ / √ / √ / √
Mandel, Josh / / √
McCaslin, Ken / / √ / √ / √
McDaniel, MaryKay / Marykay.mcdaniel@cognosante,com / √
McDonald, Clem / / √
Merrick, RIki / / √ / √ / √ / √ / √ / √ / √ / √ / √ / √ / √
Meyer, Joerg-Uwe / / √
Milius, Bob / / √
Miller, Michelle / / √
Orvis, Nancy / nancy.j.orvis@civmail / √
Perkins, Vada / / √
Pitkus, Andrea / / √ / √ / √ / √ / √ / √ / √ / √
Poehlsen, Stephan / / √
Quirk, Donna / √ / √
Reeves, Dianne / / √
Roberts, John / / √
Rosin, Caroline / / √ / √ / √
Rutz, Dan / / √ / √ / √ / √ / √ / √ / √ / √
Schlichting, Stefan / / √
Shekleton, Kevin / / √
Slack, Maryann / / √ / √
Smithies, Rik / / √
Smits, Mark / √
Snelick, Robert / / √ / √
Solomon, Harry / / √
Syed, Jenni / / √ / √ / √
Takasaka, Sadamu / / √
Telonis, Panagiotis / / √
Ting, Jeffrey / / √ / √
Topping, James / / √
Vastagh, Stephen / / √
Verhoef, Wendy / / √
Vreeman, Daniel / / √
Walker, Mead / / √
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
Q3 – OO
Agenda:
· Introductions
· Co-Chair Elections update
· Interim co-chair election
· Agenda Review
· FHIR
Introductions
Co-Chair Elections Update
· Co-chair elections are open. There are two candidates listed (Lorraine and Rob) and we are aware of one interested party as a write-in (Patrick). Voting closes Wednesday 4 pm.
Interim Co-Chair
· Motion to appoint Patrick as interim chair until position is filled. Lorraine, Ken
o Against: 0; Abstain: 1; In Favor: 10
Agenda Review
· Motion to allow the eDOS project team to proceed with ballot reconciliation on Chapter 8, and related vocabulary, and forward the results to OO for the final, consolidated vote on the overall V2.8.2 ballot. Ken, Riki
o Against: 0; Abstain:1; In Favor: 11
· Tues Q2: SPL/CPM update, FHIR resources for device, and UDI update
· Tues Q3 add nutrition to the FHIR reconciliation
· American Clinical Pastoral Education (ACPE) Request to be reviewed during admin quarter Thursday Q3
FHIR
· Various ballot items on ObsevationObservation Component
o #7517
§ Old observation had component- had a codeable concept and value, but without ref range – OO removed this from DSTU 1.0 to 1.1;
§ Current DTSU has several types of values
§ Example vital signs has several observations – blood pressure LOINC – body site and stature (sitting vs) is at the higher level that is essentially just meta data – plus 2 related values for the systolic and diastolic that also have all that meta data.
§ Genetic profile on observation has 30 extensions, all are derived observations from the core sequencing work; request is to get component observation back into the observation resource.
§ If we add component – then we need to figure out what to do with the type of “has component”
o #7639:
§ What is “has component” – vs “member” – member has meta data / component may be not?
o Other comment:
§ Related has to be another observation ONLY
§ Survey vs observation – loosen the related item up – need to review the type list – may need to add “reason”
§ When observation related to the method – do I have to mention other relationships to additional procedures.
o Remove “has component” from the list of related types
o ADD back in the component with code and value like it was - all the meta data of the observation applies to all the component elements – allow pointer from component to reference range
o Otherwise have to use the related item.
o Laboratory results would usually be separable, whereas blood pressure is a single observation.
o Eric will make the changes
o If Should we allow the component to have a reference range – since we don’t have conduction.?
o What if something goes wrong and we only have one of the two elements – it could have to be in two places? Do we need to have data absent reason on the component?
o Component: add data absent reason
o Motion to remove “has_component” and add “Component relationship” where “Component” has code/value and data absent reason. All observation attributes apply to “components” without change. If there are changes to any of the observation attributes, it is another observation. Point “Component” to Reference Range, since “Component” does not inherit Reference Range. Invariant on the “component.code” that it cannot be the same as “observation.code”. Patrick, Eric
§ Against: 0; Abstain: 3: In Favor: 10
o Do we need “comment” and “dataAbsentReason” on “component”? Only add “dataAbsentReason” to “Component”.
o Component Examples: Blood Pressure, Vital Signs (including Blood Pressure), Genomics. Point to CBC as not being a fit for component.
§ Component – inseparable. Observation attributes apply to all, except a couple of exceptions.
§ Related – separable. Observation attributes apply individually.
o 5717 closed, 7639 closed.
· 7434
o Relationship to procedure and condition
§ need use cases besides the method of the observation, which is covered in the method part of the “observation.code”
§ for “condition” anything other than “reason for observation”
§ will send these questions to submitter.
o May need to build a relationship resource to allow folks to separately create
§ Refer this to MnM for consistently dealing with the relationship
o Need better use cases to justify one way of or the other. Need a library that V2, V3, and FHIR can tap into.
o Need to collect more use cases that are more rich to test solutions against any family – will also help with conformance testing – Patrick to write PSS for use case project – order project has a few collected already
o Also, for those procedures for related, and conditions, what are the resources?.
· Priority of our review and ballot reconciliation will be:
o Observation is #1 priority; UDI (Tomorrow Q2) and device - supply and supply delivery - workflow like Order and order response later (will have connectathon for this one in Atlanta)
Q4 – OO
Agenda
· FHIR Ballot Reconciliation
FHIR Ballot Reconciliation
· Motion to have the editor address the A-Ts plus bad links. Also address incorrect vocabulary, but come back to workgroup when the examples move into substantive changes to best practices. Eric Haas, Patrick Loyd
o Further discussion:
§ what about fixing examples to reflect best practice – for example fixing incorrect LOINC / SCT code –
§ if it drifts into best practice then editor will bring to group for review substantive changes required – amendment accepted
o Against: 0; Abstain: 0; In Favor: 9
· #7898 is in person for Michelle (Cerner) so skip
o Request for grouping (in v2 we have service sector ID)
o Still means you have to nail down the value set list
o Turn that into curated lists.
o Put this on for Thu Q2.
· #6022: FHIR to CCDA mapping
o Performer short description needs to change: who did the observation?
o That is NOT the same as what the long description says, which is: Who is responsible for the observation.
o Performer in v3 Lab model is the person who performed the test.
o Motion to change the short definition – persuasive Eric, Patrick
§ Further discussion:
· How do we get the tech into the resource
· That requires a new comment, this is non-substantive, clarification, resolved, change required –
§ Against: 0, abstain: 0, in favor:9
· FHIR is waiting for feedback on this balloting process
· #6185:
o Why not use UDI instead of the “device” resource as a choice?
o If you just use UDI, then you miss out on some other meta-data
§ We may need to add “participation” to “device” as well; have “type”, which could possibly be used to imply participation
o Then you would have to have guidance on when to use which one.
o In service architecture you have multiple conversations that go on – validation of the patient, the device etc, then just sending the reference on the order or observation that should then be enough.
o Bring this to UDI discussion Tue Q2.
o UDI format has issues with the implementers
§ Paul Knapp has written a conversion software to compile depending on who issued the UDI
§ problematic, as in GS1 code you can add extra fields by the jurisdictions that create it
· #6202: background text clean up
o Should get new write up based on v2 and v3 experience
o Scope already seems to cover that
o Patrick will create recommendation for new background text, if anything
o Motion to find persuasive: Patrick, Eric,
§ No further discussion,
§ Against: 0, abstain: 0, in favor:9
· #5537:
o Moved the resolution text to follow up location in the gForge tracker
o Will check if units use coding, which has a code system version
o Value set and code system version should be part of this units of measure code
§ id only supports a code,
o So need to defer to MnM and ITS to change the datatype for “quantity”.
o Depending on the code system use of the version number is relevant, so need to add code system version.
· #5665:
o Look at the newly re-introduced “component”
o Other option is related
o This should explore the use case first and review the different solutions
o Datatype vs extension to define best practice.
o In v2 we do have the datatype of array that is similar to “component”.
· #5165:
o MnM approved addition of a new datatype of “quantity unbounded” (no range)
o OO needs to review
o Agree with recommendation that “observation.value” allows datatype choice and will create new datatype for the “unbounded Quantity”– Eric, Patrick no further discussion, against: 0, abstain: 0, in favor:9
Tuesday
Q1 OO
Agenda
· V2.8.2 Ballot Reconciliation
V2.8.2 Ballot Reconciliation
· Motion to allow the editors to address all A-Ts. Riki Merrick, Dan Rutz
o Against: 0; Abstain: 0; In Favor: 4
· All votes and dispositions are recorded in the spreadsheet attached:
o