2020-12-08 Meeting Notes

08 Dec 2020 10:00 AEDT

Attendees

@Andrew McIntyre (Co-Chair)

@Michael Legg (Co-Chair)

@Dalisay Giffard

@Jakub Sielewicz

@Jared Davison 

@Kyle Macdonald

@Philip Wilford

@Scott Ferris

@Tarun Narayan

@Tony Cruice

@Vanessa Cameron (Secretariat)

Apologies

@Angus Millar

@Brett Esler

@Christian Holmes

@Danielle Tavares-Rixon

@David McKillop

@Eric Browne

@Kieron McGuire

@Lars Becker

@Liam Barnes

@Michael Osborne

@Nick Ferris

@Paul Carroll

@Roger Hill

@Robert Flatman

@Vincent McCauley

Brief introduction to HL7 O&O wg purpose and welcome to Tarun Narayan, Solutions Architect NSWHP working on standardisation of HL7 project, joining the group for the first time

Goals:   1) Address remaining HL7v2-FHIR issues not discussed in Meeting 22 Tue 01 Dec 2020

Discussion items (included the following):

Notes from Meeting 22 on 01 December 2020 were accepted by members in attendance.

RACGP Standards with respect to safe reporting of pathology results and SPIA Standards distributed to all – if not yet received, please email @Vanessa Cameron. 

 7. Patient Referral

No feedback was received from wg on work undertaken in Meeting 22 with respect to 7.2.2. Patient Referral Acknowledgment Message structure (RRI_I12) - RF1, PID or PRD in ACK message awareness of RF1, PID or PRD currently being used in ACK message.  Decision to make all 3 segments optional as there may be sensitive patient information contained within these segments.  Proposal appears to align with both RACGP and SPIA Standards. 

RRI^I12^RRI_I12 Referral response Information message structure

Receivers must not return clinical information to the originating referrer such as reports or results in the Referral Response Information (RRI). 

The RF1, PID, and PRD  segments must echo what was received in the referral message (REF).

Note that the RRI may contain personally identified information, therefore the handling of the message must account for the potentially sensitive nature and that RF1, PID, PRD may be group has been made optional in future versions for privacy reasonsfor backward compatibility.

7.3.3 PRD - Provider Data segment should reference Appendix 10 PRD mapping on how to do Ref message addressing as currently missing, similar to A8.12 Addressing; wording to be clarified.  Now incorporated in its own subsection 7.1.2.1 Addressing

...

Appendix 8 defines a simplified referral profile. Section 7 Patient Referral defines a number of segments which allow more complex referral interactions but also have a significantly higher level of difficulty and use of this functionality will require negotiation with endpoints. For most purposes the simplified referral messages is recommended. Appendix 8 makes reference to this section for details. 

7.1.2.1 Addressing 

The provider or facility identifier (in PRD-7) for the PRD marked with IR meaning "Intended Recipient" (in PRD-1) is used to address each instance of the message to an endpoint. Appendix 10 defines field mapping for addressing individual instances of a REF message to a provider or healthcare facility when using the Australian Profile for Provider Directory Services. 

7.1.3 Patient referral and responses

...

When sending a referral message to another provider, the intended recipient for the instance of that provider message must be identified. Only one provider PRD segment may be marked the intended recipient (IR) specified in the provider role field.

...

 7.6 Correcting referrals and 9.3.2.2. RF1-2 Referral priority (CE)

 Added instructions for correcting referrals sent in error (new section 7.6 Correcting referrals sent in error added) plus reference in RF1-1.

 ...When a corrected referral snapshot is sent, all information from the previous snapshot identified by the same RF1-6 Originating referral identifier (EI) must be replaced with the current snapshot. e.g. Allergies, Medication, Results, etc.

See section 7.6 Correcting referrals sent in error. 

7.3.2.2 RF1-2 Referral priority (CE) 

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>

...

Referral messages may contain multiple display segments.

7.6 Correcting referrals sent in error 

No delete mechanism exists for REF messages and if a report has been sent in error, then this should be stated in a correction to the original message with the same RF1-6 Originating Referral Identifier. Use Correction status in RF1-1 to indicate this. 

4. Observation Reporting

HL7OO: Fix LN errors in examples below.

ORC|RE||2.25.263498878813690208021966154988434320272^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN

OBR|1||2.25.263498878813690208021966154988434320272^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|18842-5^Discharge Summarization Note^LNote^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830

OBX|1|ED|18842-5^Discharge Summarization Note^LN||^application^x-hl7-cda-xdm-zip^base64^UEsDBBQ

OBX|2|ED|HTML^Display format in HTML^AUSPDI||^text^html^Base64^PD94bWwgdmVyc2lvbj0iMS4wIj8+Cjwh....

OBX|3|ED|PDF^Display in PDF Format^AUSPDI||^application^pdf^Base64^JVBERi0xLjQNCiXi48/TDQolDQol...ORC|RE||12123-1^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN

ORC|RE||12123-2^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN

OBR|3||12123-2^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|52033-8^General correspondence^LN Note^LNote^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830

OBX|1|ED|52033-8^General correspondence^LN|2|^application^octet-stream^Base64^...||||||F

OBX|2|ED|PDF^Display format in PDF^AUSPDI||^application^pdf^Base64^...||||||F|||20170322

ORC|RE||12123-3^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN

OBR|4||12123-3^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|52033-8^General correspondence^LN Note^LNote^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830

OBX|1|ED|PDF^Display format in PDF^AUSPDI|Supporting Letter|^application^pdf^Base64^...||||||F|||20170322

OBX|1|ED|RTF^Display format in RTF^AUSPDI|Supporting Letter|^application^rtf^Base64^...||||||F

ORC|RE||12123-4^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN

OBR|5||12123-4^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|52070-0^Workers compensation^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830

OBX|1|ED|PDF^Display format in PDF^AUSPDI|claimform1|^application^pdf^Base64^...||||||F|||20170322

7. Patient Referral

* UPIN must be used for Australian Medicare Provider numbers. 

** NOI is not present in the most recently published table of HL7 0203 in HL7 v2.8.2, though it is has been accepted for publication in HL7 V2.9. The allocation of these identifiers is not always at the correct level of granularity and many organisations are not registered and alternative identifiers are often used. Pathology Labs are identified using the AUSNATA code with there NATA number. 

...

 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

•  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

• 64. @Jared Davison tried to move A11.3 The Indication of Consent into draft Standard as an appendix, but has a lot of PCHR-specific content, not generic enough for O&O.  Needs governance to review before next meeting

New Meeting actions:

• 65. RACGP Standards with respect to safe reporting of pathology results and SPIA Standards distributed to all – if not yet received, please email @Vanessa Cameron. 
• 66. Noted that final meeting will focus on reviewing all remaining comments to ascertain if draft Standard is ready for public comment

 Final Meeting for 2020: Tuesday 15 December 2020 @ 10:00 – 11:30 AEDT

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