IHE Lab Domain Minutes 01/25/2011

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  • Sondra Renly (IBM, IHE Technical Committee Co-chair)
  • Francois Macary (ASIP Sante, IHE Planning Committee Co-chair)
  • Andrea Pitkus (CAP, IHE Laboratory Secretary)
  • Ed Heierman (Abbott)
  • James Harrison,MD,PhD. (CAP, University of Virginia)
  • Andrzej Knafel (Roche)
  • Jean Benech (bioMerieux)
  • Naomi Ishii (Hitachi)


1. North American Connectathon Report http://www.ihe.net/Connectathon/upload/IHE-NA-Connectathon-Conference-2011-Agenda.pdf

  • IHE Connectathon Notes
    • 87 companies from XDS profile.
    • 100 companies, 55 profiles.
    • IVD connectivity is a small part of the overall problem. It is layered underneath the Laboratory Connectivity
    • Multiple implementations for Laboratory interoperability
      • ELINCS
      • HITSP
      • Others, such as LTW profile
  • ONC is working on the EHR interfacing standards with the Analyzer Manager as actor.
    • This will be between the LIS and the EHR with the pilot testing in Sept 2011. HL7 has built an implementation guide for this. Prior ELINCs was an implementation guide. We should coordinate concerning semantic interoperability.
    • ELINCS did not handle orders, just results. This was discussed at HITSP in the past with IHE Lab promoting LTW. The result was 2 messages all based on HL7 2.5.1. We need to work on the semantics more, continuing previous IICC work. This will occur between the Analyzer manager and the device. There may be overlap with vocabularies with EHR and instrument communication. IT is within the scope of the LAW profile. Rob Bush is interested in a project to use LOINC for test code mappings. We should work on a standard set of LOINC codes and work with vendors on mapping. Work will be needed before the next LOINC meeting.
      • This is US specific and message based. HITSP was allowing documents or messages.
    • Meaningful Use Lab was defined for Public Health Reporting which originates from EHR. Concern is the duplication of results both from lab and EHR. Doctors don’t have the lab based rule based systems on notifiable conditions. It varies between states. IHE QRPH is Quality Research Public Health Domain. Electronic Lab Reporting (ELR) needs to be up and functioning by Oct 2011. This is for only the public health notifiable conditions, which vary by state. Many notifiable conditions come from labs directly. People will be looking at how the ELR message how a report is marked as notifiable reusing an extended vocabulary such as high, low reportable. This will be ongoing. It will fit into the US S&I framework with the international HL7 framework with potential international impact. In document, it’s easy to specify notifiables, but it’s not built in to the HL7 messaging specifications currently. Rules and logic will changes as notifiables change. US won’t be going to HL7 2.7, but some are still trying to implement 2.3.1. Question about what it is being used in LAW baseline
    • One of the previous spreadsheets highlights the differences in the standards so HL7 2.3.1 and HL7 2.5.1 can be used. LAW is expecting to use HL7 2.6 or HL7 2.7. If no message extensions are needed, we could stay in HL7 2.5.1. There are significant differences in “clean” concepts supported by the different versions. There was a discussion at HL7 in Boston with O&O. It’s important to view from market readiness and standard readiness perspectives.
    • We have options. Need to consider Japan, US, Europe and also LIS vendors.
    • ONC is ready for someone to come up with solution for lab interoperability. HL7/HITSP uses two implementation guides without harmonization. There has been attempts to harmonize in past, but may be needed in the future. ONC is looking for Statements of Commitment from Companies currently. Sondra can report on this regularly
  • Supporting the LAW Profile
    • Tools
    • Open source implementations
  • Apply the S&I (Standards and Interoperability) approach on a smaller scale (from Dr. Fridsma)
    • Profiles, Standards
    • Reference Implementation
    • Pilot projects
    • Compliance Certification
  • Robustness (based on TCP/IP RFC)
    • Send Conservatively – constrain what is sent
    • Receive Liberally – adapt if necessary to receive what is sent
  • Keep it simple
    • Clarity
    • Concise
    • Minimum set of capabilities to solve the problem
    • Add features incrementally
    • Don't let perfect be the enemy of good
    • Harmonize with the "little guy" - be inclusive
  • Connectathon preparation
    • Simulation tools required for prior testing. This would include data sets. As part of the pre testing work, much of the software is tested internally and then externally with other actors.
    • Determine what aspects of the profile will be tested
      • Actors
      • Transactions
      • Use cases?
  • Determine what coordination is needed with IHE Connectathon project managers. Steve is excited to have IHE Lab testing in 2012. Sunquest also expressed interest in testing. Most of the IHE Lab Domain new members of the list each week are from North America.
  • Leverage experience of IHE team members to help us prepare Tooling is needed. Biggest question is what are the use cases to test? What about labs that perform select testing? How can we remain universal across many labs? We need to coordinate with Eric Poiseau and Steve Moore. Pre connectathon testing -Steve Moore is good about gathering information for the Use Cases and testing process. It’s good to have an “outsider” reading the profile and understanding the requirements, use cases, implementations, tools, etc.
    • There is discussion of the tooling and Connectathon process. Gazelle is the tool with the platform and framework in managing the tests. It has a library of validation services. Analyzer side querying a sample and be told which test should be run and it should run with results to the other actor. Can Gazelle support this? Gazelle and Lab has been tested in Europe and so there is experience here. However, lab data sets are needed. Start simple to get success in testing, but keep in mind additional features or bugs will be worked out.
  • CP Ballot Update
    • We have CPs through 167. Question about Technical Framework Vol 3, page 47 (in profile under development on FTP site) concerning specimen collection and received. (ftp://ftp.ihe.net/Laboratory/ihelabyr-2011-2012/Technical_Framework_v3_InProgress/) Specimen Collection template does not include Specimen Receive template. There is a desire to have a pointer back to this.
    • CP150 also included. The plan is to get this out tomorrow for public comment. Balloting will occur on the Google Group to vote. The eligible voters list will be provided to Sondra by the end of the week. The ballot should take 3 weeks. An email will be sent to the cross domain co chairs too.
  • LAW Profile Volume I
    • Pooling of Patient Specimens Call scheduled for 26Jan2011
  • LAW Volume I Technical Discussion
    • Review the comments from the doc from https://docs.google.com/document/d/14tX0soHvNDsdcK7Q9sjpvu79p55lDgcb2ZckjmrN82g/edit?hl=en&pli=1#
    • ELDA will be changed to LAW. There is a question about depth of use case definitions. Granularity of response wasn’t covered in the use case. Example on X 2.2 Query for AWOS is at specimen arrival. Central object of use case is analytical work order step (AWOS), query and response. See LAW workflow page, diagram on LAB XX Sequential Query. Each test can be queried. Need to determine what to include in Vol 1 and Vol 2. Is the unit the test or the test order? Can the individual tests be identified?
    • Instruments may have different capabilities, such as rejecting an order when reagents are low. The use cases need to be flexible in rejecting an entire order or part of an order. Desire to discuss Vol 1 and this appears to be Vol 2. Vol 1 is for more generic descriptions without messages. Do we need 2 use cases or 1 then? Volume 1 will focus on use case and then expand in Volume 2. Francois will capture argument in AWOS definition.
    • LAW should not reference LDA since they were split. LAW will be a complete separate entity. See Section X 3 System interconnection in laboratory. LIS, Devices, Middleware etc connections. Francois will rewrite from Chicago Face to Face discussions.
    • Refer to X.6 Process Flow and second diagram. 3 transactions on X.4.
    • Next reference X. 2-Uses cases. Francois to review prior to X.2 (at the to be continued point). Refer to X. 2.1 TBC highlighted section. Propose that comments be addressed offline. Provide answers to all and copy to Jean Benech and Christophe. Please provide answers within 1 week.
    • Put the documents together and get feedback

Next Call/Meeting

Next regularly scheduled IHE lab call will be held on Tuesday, February 8th 2011 from 8:00-9:00 AM (Eastern Time, NYC)