2018-02-13 Meeting notes

Idea about “decoupling” of atomic results (OBXs) from their Universal Service Identifiers (OBRs) for the purpose of display ?

The following has been seen in two EMR systems:

The results grouping that is determined and sent by the Laboratory system is being ignored by the receiving EMR system.  Rather, the EMR presents the result under a laboratory discipline group.

For example, a haemoglobin result might be presented under a generic “Haematology” group rather than it’s “Full Blood Count” panel name that is sent in OBR-4. Coagulation results may also appear under “Haematology”.

Another example is the Lymphocyte Subsets panel results being presented under an “Immunology” group, with the White Cell Count that is sent with this panel being separated and presented under “Haematology”.

This seems to be messing with the integrity of the results but I can’t see anything specific in the O&O standard that states that the results must retain the grouping as sent by the Laboratory.

Message traslations where the original laboratory grouping is being lost/ignored in translation. Example where result grouping for FBC, Malaria screen and IMmulogy eg CD3 results were dissassociated.

Michael; Thought there was potential for disaster. The results are grouped by the lab and the standard does say that there should also be a rendering of the laboratory has intended the report.

Daliday: pdf rendering is not avilable.

Andrew: Shouldn't send same result under 3 different headings eg WCC sent with FBC, Malaria and CD3/4 results. Should only send the WCC count once and Andrew understood why the WCC was bring displayed 3 times. Same data under multiple OBR causes issues - need to have an algorithm to say the test is the same the data is the same and jsut show one.

Andrew - a rendering of the report should be provided.

Jared: issue is that there needs to be a way to identify the OBX in multiple reports.

Jared: look at issue in standard to know the result came from the OBX ie in FHIR there is an identifier to know this.

Andrew: each OBR should have a unique ID. Should have a way of addressing where want one part of a report in another report.

Michael: same issue is with Structured Cancer reporting ie content taken from multiple reports is assimilated into a final report.

Dalisay: Sunquest use the international standard and may have a solution.

Jared: OBX-21 in HL7 V2.6 has been re-purposed (query iof that term is correct) may be used for this type of issue.

Andrew:

Dalisay: Sunquest use NTE segment extensively for commenting. The Sunquest display is not liked by QH. Daliday is just ensuring following the Austrlaian standard.

Jared: Consider pre-adopting OBX-21 (V2.6) into the draft.

Dalisay: to look more at filler order numbers.

Andrew: there has been an Auslab issue with QH filler order numbers. However, the uniquenss of OBX's does need to be solved and suggest Jared & Andrew go and think about a solution.

Michael: document to be distribuited to c'tee for comment.

Michael: to show to AACB and the Agency to show what's to be done to get the job done properly.

Peter: Discussed the docment on source header codes.

• discussed the "Record artefact" hierachy and the good working relationship with NCTS.
• Benefit of using the SNOMED "Record artefact" is that structure can be incorporated. Currently "Record artefact" is underspecified, but has potential.

Discussion with the HL7 Au Board:

1) Board asked O&O regarding foreseeing any issues with dissolution of the HL7 Au Technical meeting.

2) Discussion regarding the resource who does the Confluence editing and pdf rendering

• Wil at Brasskazoo.com (? spelling) is doing the work.

3) Other Board Stuff:

1) Michael - doesn't think there would be a significant impact with the dissolution of the Technical meeting.

2) Andrew - pdf export does require tweaking

Michael - Wil is a valuable resource and O&O would like more work to be done by him. Jason - the board is committee to support the WG's and Jason will take it to the board and should be supported.

Andrew - requested to allow Will to have improved privieges as he's had to export to his machine and progress frmo there rather than do it on the HL7 Au Confluence site.

Jason - some discussion on Wil's current payment status.

Jason - dissolving of the TSC was intended to provide more support for the WG's.

Jason - Other items include a quote from Zoom to run the meeting rather that GoTo. Zoom can allow 50-100 participants on camera.

Michael -GoTo works and using HL7 Au account. Michael hasn't used Zoom.

Jason - with GoTo 2 WG's cannot meet simuilataneously and if the meeting organiser doesn't show then the meeting cannot progress cf Zoom allows multilple meetings and more than one to start the meeting. GoTo is expensive if have more than 1 account.

Richard - IHTSDO uses Zoom. Richard has found GoTo easier to use than Zoom, but Zoom seems more popular with the more professional organisations.

Jason - looking for an option for a professional suite ie an infrastructure that supports WG's.

Michael - willing to try and will inform of any issues.

Jared: Asked about engaging Wil (Brasskazoo) to do more work.

Jason: will take it to the board.

Jared: Need a mechanism to produce drafts with the appropriate marking that it's a Draft and what is the static version.

3) Other Board Stuff:

Brett: wants to put up an Ontoserver for terminology and needs to be discussed with the board. Supporting the publishing is important.

Dalisay: QH has a project working of Newborn health which was agreed is relevant to the new potential HL7 Au WG.

Heading and titles in REF and Pathology:

• Peter Scott has written a discussion paper

Andrew & Michael: HL7 V2 has been the priority to get the content standardised to promote ineroperability.

HL7 V2 standardisation would not be wasted with FHIR standardisdation.

Andrew: Important not design in a model and then implement in a technology. Really not a lot of difference between HL7 V2 modle and a FHIR model.

Modelling in a technology neutral and therefore Medical Objects may look at implementing in V2 cf others may want to do FHIR.

Brett: A child heath group want to do modelling and progress work.

Andrew: Invited those who want work being done to come along to a O&O WG to discuss.

Brett: This new work runs across multiple WG's and therefore needs harmonisation to ensure tthe work is aligned.

Andrew: Asked if the work was under a summary in SCT hierarchy. Should put the Referral work under a Summary hierarchy (SCT).

Andrew: Should also model in the radiology work. Even pathology OBR codes are a "mish-mash".

Peter/Michael: on using the correct hierarchy ie report rather than procedure.

Andrew: Due to dropping the ORC, the hierarchy will provide the additional information required.

Michael: should use same terms but from different hierarchies.

Andrew: can use procedure in OBR-4, but need to abstract away from use of procedure hierarchy for the use in the header fields.

Jared: expressed concern that there could be misinterpreation but some systems that used the procedure code and translated it to an inappropriate field.

Andrew: Update the standard with a code in OBR-4 and haven't yet decided which code to use.

Michael: Also need report headers in structured cancer reporting where the reportatbale header will never be ordered.

Andrew/Michael: to have further discussions with Scott Campbell (Nebreska).

Andrew: Use the codes is a common issue across all observations.

There was some discussion on use on content in IN segment, but this was not captured in the minutes.