2020-11-03 Meeting Notes

Date: 03 Nov 2020

Attendees

@Andrew McIntyre (Co-Chair)

@Michael Legg (Co-Chair)

@Kieron McGuire

@Kyle Macdonald

@Nick Ferris

@Philip Wilford

@Scott Ferris

@Tony Cruice

@Vanessa Cameron (Secretariat)

Apologies

@Angus Millar

@Brett Esler

@Christian Holmes

@Dalisay Giffard

@Danielle Tavares-Rixon

@Lars Becker

@Liam Barnes

@Michael Czapski

@Michael Osborne

@Paul Carroll

@Roger Hill

@Robert Flatman

@Vincent McCauley

Goals: 1) Address remaining HL7v2-FHIR issues not discussed in Meeting 19 Tue 20 Oct 2020

Discussion items (included the following):

Notes from Meeting 19 on 20 October 2020 were accepted by members in attendance

1. Introduction – updates drafted by @Nick Ferris & @Andrew McIntyre to cover radiology & clinical referral were reviewed; all agreed value in incorporating a new note on ‘Use of consistent specifications’ and the difference between a message and a document with respect to CDA, V2, plus potential changes with respect to FHIR

Invitation to HL7.au Strategy Workshop 2020 (Friday 06 November) sent to @Andrew McIntyre & @Michael Legg; all agreed HL7 O&O member input required especially re future direction and standardisation of FHIR for pathology, radiology, other diagnostics

A10.1 Addressing messages Introduction – updated to incorporate messaging for pathology based on Provider Directory information. Information extracted from Appendix 8 Simplified REF Profile (A8.12 Addressing) and moved into Appendix 10, including A10.1.2.1. XCN Datatype. Consider adding reference to patient’s ability to receive data in standard electronic format in future, especially with respect to FHIR. Remove Australian Profile Directory Services heading entries since the entire page relates to this now.

Further text added:

For the Depending on the message type Individual recipient addressing is achieved using either the HL7 XCN datatype or for referral message individual provider/recipient level addressing is performed using the PRD segments. Although for a specific message only 2 providers are necessary, additional providers involved with the patient care must also have their PRD segments populated from a reliable provider directory source such that receivers can utilise the information and include those providers in future correspondence, this means that PRD-2 and PRD-7 must be populated for a all PRD segments according to the same rulesSee the sections below for mappings for each.

For ORU messages PV1-9 (XCN datatype) is designated as the target provider for the message.

A10.1 Addressing messages using Australian Profile for Provider Directory Services (Normative) – addition of XCN Anchor

For ORU messages PV1-9 (XCN datatype) is designated as the target provider for the message.

Anchor

XCN

A10.1 Addressing messages using Australian Profile for Provider Directory Services (Normative) – update XCN text

This XCN data type (see section 3.29 XCN - extended composite ID number and name for persons) is used extensively appearing in the PV1, ORC, RXO, RXE, OBR and SCH segments, as well as others, where there is a need to specify the ID number and name of a person.

Below are a list of common XCN datatypes contained within message segments. The PV1-9 Target doctor, OBR Copy doctors, Target doctor is critical for result delivery on ORU messages, OBR-28 Result copies .

Result copies to informs the receiver of other recipients of the report, and in the context of an order message (ORM) allows specification of result copy recipients.

Populating these fields correctly allows for querying the provider directory for further information about the provider.

The sending system should populate these fields according to the provider directory information which will facilitate downstream directory reverse lookups on the provider identifier either on the PractitionerRole or HealthcareService resource.

Two classes of provider are supported:

Individual Practitioner providers
Healthcare Service Providers

Each class of provider has different mapping rules for population from the provider directory into XCN datatype component and subcomponents.

Discussion point: Normal practice when reporting, for the system of the person writing the pathology report to distribute any electronic ‘copy to’ documents. Further information available on ‘copy doctors’ and how to utilise properly under General Conformance Points in Appendix 5 Conformance Statements (Normative)

A10.1.2.2 PRD Segment addition:

Although for a specific message only 2 providers are necessary, additional providers involved with the patient care must also have their PRD segments populated from a reliable provider directory source such that receivers can utilise the information and include those providers in future correspondence, this means that PRD-2 and PRD-7 must be populated for all PRD segments according to the same rules.

Appendices – individual Appendix headings labelled with a suffix to indicate whether content is Normative or Informative

Indication of Consent - HL7 Version 2.4 (Draft 2017) – currently a separate document, all in agreement to include as new Appendix in draft Standard as has already been implemented

3 Datatypes – 3.29 XCN – extended composite ID number and name for persons – addition of instruction in XCN about FHIR PD use

...

The XCN data type is used for doctor references including the referring doctor (PV1-8) Referring doctor, the receiving doctor (PV1-9) Consulting doctor and result copies to (OBR-28) Result copies to.

In the Australian context, where possible, XCN data must be populated using the method described in Appendix 10 Addressing messages using Australian Profile for Provider Directory Services (Normative).

Example:

|7654321A^Brown^Julie^^^Dr^^^AUSHICPR|

Discussion point: All agreed to hold over integrating Medical Document Management (MDM) using CDA and all V2 information necessary for Australian use until after current Draft Standard has been balloted and approved

3 Datatypes 3.29.16 Name context (CE) – Consider specifying PR and HCS to assist consuming systems in understanding mapping

4. Observation Reporting 4.1 Purpose – removed sentence, fixed heading (missing from Table of Contents), spelling errors and omissions updated as per below:

In this Australian guide however, we foprogressed logical model,cus on Laboratory results.

Moreover, observations that are usually reported as text (e.g., the review of systems from the history and physical) can also be considered a set of separately analyzable analysable units (e.g., cardiac history, pulmonary history, genito-urinary history, etc.). We strongly suggest that all text clinical reports be broken down into such separate analyzable separate analysable entities and that these individual entities be transmitted as separate OBX segments

726TS 00241Observation Date/Time # - OBR-7 Optionality missing. Believe it should be C

.

4. Observation Reporting 4.4.1.2 OBR-2 Placer order number (EI) 00216 -

Note: The field length of 250 characters is a variation to the HL7 International standard which has a length of 22 characters.

Placer order numbers are not specifically required in patient referralsoptional in patient referral messages (but OBR-3 Filler Order number below are required).

Anchor

	OBR-3
	OBR-3

4. Observation Reporting 4.4.1.3 OBR-3 Filler order number (EI) 00217 –

...

Definition: This field is the order number associated with the filling application. It is a case of the Entity Identifier data type (See Datatypes, “EI - Entity Identifier”). Its first component is a string that identifies an order detail segment (e.g., OBR). It is assigned by the order filler application. This string must uniquely identify the order (as specified in the order detail segment) from other orders in a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time. The second through fourth components contain the filler the original authoring filler site ID, in the form of the HD data type (see Datatypes, “HD - hierarchic designator”). The second component of the filler order number always identifies the actual filler of an order. Since third party sites/applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the filler application ID in this field may not be the same as any sending and receiving application HDs (as identified in the MSH segment).

...

Messages other than order messages must have the filler order number present and must use qualify the identifier using the site identifier (HD components: namespace, universal id, universal ID type of EI) of the authoring organisation which allows for the unique identification of the document across all practices.

The filler order number includes the site identifier of the organisation that generates the document/result/referral and the entity identifier (generated by the clinical application) which must be unique to each document/result/referral, within the same filler site, over time. This should allow for corrected documents to be issued (using the same OBR-3 Filler Order number (EI) as the original document).

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Outstanding Meeting actions:

17. @Brett Esler - Update links to all Standards on the HL7 Australia O&O WG page – Australian Diagnostics and Referral Messaging – Localisation of HL7 v2.4 Standard is still referenced as ‘Current Draft Standard’ as per https://confluence.hl7australia.com/display/OO/Current+Draft+Standards – pending
32. @Kieron McGuire - Contact @Brett Esler to have pages for Profile URIs (FHIR Provider Directory) & update link for FHIR R4 Value sets to return user to correct version of HL7 Standard
33. @Jared Davison – create a checklist prior to final draft Standard being published
41. @David McKillop to provide presentation on ADHA Diagnostic Report FHIR Implementation Guide (20 – 30 mins) after 06 October meeting
43. @Jared Davison to review draft Standard to ensure no other reversions have occurred
45. @Jared Davison to prepare PDF of draft Standard
47. @Dalisay Giffard to share authorised outcomes of Queensland Health meeting discussions on gender identification

New Meeting actions:

54. @Jakub Sielewicz to ensure @Jared Davison’s work on A10.1 Addressing messages Introduction is consistent with ADHA’s Secure Messaging Implementation Guidance Paper
55. @Jared Davison to incorporate Indication of Consent - HL7 Version 2.4 as new Appendix listing