Lab Meeting Minutes Oct 2013

Attendees:

Nobuyuki Chiba – A&T

Jim Harrison – University of Virginia / CAP

Yoshimi Hirasawa – Techno Medica

Genichi Kato – Saiseikai Shiga Hospital

Tsuyoshi Kawata – Itec Hankyu-Hanshin Co.Ldt.

Laurent Lardin – bioMérieux

François Macary – ASIP Santé

Kimiko Matsuoka – Osaka General Medical Center

Riki Merrick – APHL

Filip Migom – MIPS

Ishii Naomi – Hitachi high-tech

Hiroyoshi Okada - Itec Hankyu-Hanshin Co.Ldt.

"Salt" Yasunari Shiokawa – AJS Inc.

Shinishi Watanabe – A&T

Osamu Yamada – Okasaka City Hospital

Shigeki Yokoyama – KD-ICONS Co.Ldt.

Results of the cochair elections

announced by Jim Harrison on behalf of Mary Kennedy the IHE LAB secretary

Two cochairs elected:

• Riki Merrick – Planning
• François Macary – Technical

Osamu Yamada and Sondra Renly having expressed the will of not taking a new term as cochair, the IHE LAB committee current governance team is as follows:

• Planning cochair: Riki Merrick
• Technical cochairs: François Macary, Yoshimi Hirasawa
• Secretary: Mary Kennedy

Those 4 people are the ones associated with the email box lab@ihe.net

The committee members are grateful to Sondra Renly and Osamu Yamada for their fruitful two terms [2009-2013] served as cochairs.

LAB Technical Framework – scope, current publications

See presentation: LAB Tokyo meeting opening

Publications expected end of October on www.ihe.net, that will be the basis for 2014 connectathons:

• LAB TF R5.0 (5 CPs integrated),
• LAW R1.3 (19 CPs integrated),
• ILW R1.2 (1 CP integrated).

Controlled coded vocabularies for microbiology

Study on Standardization of Various Masters in Microbiology

Study contributed by:

• Kimiko Matsuoka– Osaka General Medical Center
• Shigeki Yokoyama – KD-ICONS Co.Ltd.
• Takashi Noguchi – Tokyo University
• Genichi Kato – Saiseikai Shigaken Hospital
• Kazuyuki Nakayasu – Ministry of Health, Labour and Welfare

Slides presented by Kimiko Matsuoka: Masters for microbio]

4 level classification of microorganisms

4 level classification of anti-microbial agents

Discussion:

• The classification of microorganisms presented goes as far as the species of the microbe (the last 3 digits of the identifier). It does not distinguish strains nor genetic mutations on a species.
• LOINC. IHE LAB Volume 4 (LOINC subset) has been deprecated in 2010. The number of active LOINC codes available for microbiology in the current release 2.44 of LOINC is:
  • 1,682 codes for Antibiotic susceptibility testing (class = ABXBACT), in general 4 LOINC codes available for each antibiotic tested, one for each of the 4 methods:
    • MIC (Minimum Inhibitory Concentration)
    • MLC (Minimum Lethal Concentration) synonym to MLC (minimum bactericidal concentration)
    • Agar diffusion
    • Gradient Strip
  • 10,236 codes for the rest of microbiology (bacteriology + parasitology + mycology)
• The SNOMED codes studied are extracted from an old release SNOMED 3.5 or SNOMED RT. The current release, SNOMED CT (Clinical Terms) uses pure numeric and non significant identifiers. And the microbiology part of it is produced by microbiologists. There is no particular order in the SNOMED CT concept, since the identifiers are non-significant. Each concept is determined by its relationships to other concepts. See http://www.ihtsdo.org/snomed-ct/
• IHTSDO is re-working the organism hierarchy in SNOMED CT, to include organism’s attributes but keeping the Linneean hierarchy clean – from class to subspecies and subtype.
• The interest of using non-significant identifiers, like in LOINC and SNOMED CT, is that it eases the maintenance over time of the terminology:
• A class of concepts (e.g.; staphylococci) is not limited by a pre-reserved series of codes (what would happen in the Japan Master microbe classification if there were more than 999 species under one genus?)
• The codes are independent of the sorting order of concepts (what would happen in the Japan Master microbe classification if a particular species were reclassified under another genus?)
• The master classifications presented are used in several hospitals in Japan. They are maintained over time.
• These master classifications will be presented to the American Society for Microbiology (ASM) next year.

Progress of the coded vocabularies for microbiology in France

Slides presented by François Macary: Vocabularies for microbio French WG

• New CP needed to allow the usage of field SPM-5 (specimen type modifier), necessary in microbiology --> Action item for François
• Next meeting of this work group is in November. The major issue left to be solved is what coding system for microorganisms.
• Notification from Riki : Specimen cross mapping table is posted here: http://www.phconnect.org/group/laboratorymessagingcommunityofpractice/forum/topics/labm-cop-notes-files-and-link-to-recordings-starting-8-8-2013 Scroll to the last reply for the latest version – happy to have more folks participate in reviewing the definitions etc – call are 2nd and 4th Thursday 10 AM – 12 PM EST. Email Riki for call information.
• Riki: In US for ordering will use local codes as the master, if there is a LOINC that is acceptable, then it should also be sent – CPT codes in the US are used on the re-imbursement side, not granular enough for ordering – if single test, LOINC is very usable, but not for batteries – not well defined components and not resolved how to represent reflex testing
• Message structures: Using specimen centric message structures in France (OML^O33, OUL^R22). The US for certification are using the order centric messages (OML^O21 and ORU^R01).

Evolution of HL7 table 0078. Usage for microbiology

Slides prepared by Riki Merrick and Laurent Lardin, presented by Laurent Lardin: HL7 Table 0078

Discussion:

• Six codes available for the interpretation of antimicrobial susceptibility: S, I, R, NS, SDD, IE
• Will discuss adding SYN-R and SYN-S this week at HL7 OO to cover when two or more anti-microbial substances either help or hinder each other.

Usage of reference terminologies SNOMED CT, LOINC, UCUM

Slides presented by Filip Migom: Semantic interoperability

Additional slides by François Macary: lab test comparable results

Discussion:

• One of the biggest disincentives to the adoption of SNOMED CT is the cost: Annual license fees for the country + national organization to be set up for contribution to IHTSDO, translation, promotion of the usage.
• Is RxNorm only US – we think yes – is produced by National Library of Medicine in US – more info here: http://www.nlm.nih.gov
• Browsing on the Nictiz terminology explorer
• A SNOMED CT concept is primitive when it just has the parent (and child, if available) relationships defined.

Usage of reference terminology JLAC-10 in Japan

Slides presented by Osamu Yamada: JLAC10

Discussion:

• JLAC10 (Japan Laboratory Analysis Code version 10) is an alphanumeric coding system for laboratory tests enforced by the Government and scientific societies.
• JLAC10 provides a 15-digit code for ordering a test, and one or more 17-digit codes for reporting the results of the test.
• The major issue discussed was about the specific usage of the HL7 message structure made by JAHIS (slides #12 and #13): In Japan, the laboratory tests are ordered via OBX segments (OBX-3 carrying the JLAC10 test code) instead of OBR-4. In the messages used in Japan, OBR represents the “Order Group”, and each test is carried by an OBX segment below. This usage is not compatible with the usage of HL7 in America or Europe: One OBR for each service (e.g.; lab test) ordered.
  • OBX segments are used only to let the ordering physician provide observations along with the order (such as patient temperature accompanying on order for blood gas, or urine volume accompanying an order of chemistry on a urine specimen).
  • In other countries the example ordering message shown in slides 12,13, would look more like this:

MSH|…|OML^O33…

PID|…

PV1|…

SPM|…

ORC|NW|||Ordergroupnumber1|...

TQ1

OBR|1|ordernumber1||3A0150000022271^急 アルフ゛ミン^JC10|…

ORC|NW|||Ordergroupnumber1|...

TQ1

OBR|2|ordernumber2||3A0100000022272^急 ＡＳＴ（ＧＯＴ)^JC10|…

ORC|NW|||Ordergroupnumber1|...

TQ1

OBR|3|ordernumber3||3B0150000022051^急 CK-MB^JC10|…

...

Testing environment and validation tools in Japan

Slides and demonstration by "Salt" Yasunari Shiokawa: Introduction to tools

Discussion:

• Japan connectathon is putting the biggest effort on the workflow testing (group testing), whereas Europe and North-America (NA) connectathons spend more time on peer to peer tests.
• Given the very limited number of monitors at Japan connectathon, most of the verification has to be automatically verified. This is made possible by:
  • The Transaction Monitor, which captures and records the content of all transactions (vendors have no choice on that, unlike the optional feature of the “proxy”, which enables the same results in NA and Europe, if it is configured by vendors).
  • The Validation Engine.
• It was the first time that those latest tools were demonstrated. It was a success.

Update on LCC profile

Update presented by Jim Harrison: LCC

Discussion:

• US deal with orders. An order carries a single service (battery/panel or test). In Europe and Japan, laboratory requisitions often involve a group of orders related to the patient condition. And a global interpretation across orders is expected. In the standard, the concept of group of orders is only supported by field ORC-4.
• How do you ask for an interpretation across several orders and results? The solution can be by using a dedicated battery code with the meaning “Overall interpretation”, associated with an additional (OBR, ORC) pair.

Conclusions:

• The consensus of the committee selects these choices:
  • LAB-6 extends TQ1 by one field, and adds new codes for ORC-1 and for ORC-5 and ORC-16.
  • LAB-7 leverages the child order mechanism and does not need any changes to the standard.
• The standard associated with this profile will be HL7 2.9 if it’s available when the profile is published, otherwise 2.8.1 with pre-adoption of the new features brought by 2.9 or 2.8.2.

Action items (Jim):

• Submit to HL7 O&O WG the ultimate choices for LAB-6 and LAB-7.
• If O&O agrees to this path, prepare a change request for 2.9 (or 2.8.2) proposing the extended codes and fields.

Upgrade of LAW test scenarios for 2014 connectathons

Discussion led by François Macary

The table below synthesizes the changes planned:

Testing scenario	Status	Action Item
Setting up the Test & panel code set (for AM and Analyzer)	Add new codes for microbiology	Laurent proposes first additional list to Ed
Normal process with query	Scenario is correct with LAW R2. The group acknowledges the fact that an Analyzer may be bidirectional and support only the broadcast mode. No change other than language cleanup.	Laurent checks with Ed that some analyzer may support only the broadcast mode. Maybe some clarification of the wording of “bidirectional option” to bring via a CP
AWOS broadcasted before specimen arrival	Scenario is correct with LAW R2. No change other than language cleanup	Language cleanup by Riki
Manual urgent AWOS	Scenario is correct with LAW R2. No change other than language cleanup	Language cleanup by Riki
AWOS broadcasted and then updated prior specimen arrival	Scenario is correct with LAW R2. The choice is to cancel the initial AWOS and issue a new one rather than dealing with replacements and updates. Language cleanup	Language cleanup by Riki
Exceptions in the query	Scenario is correct with LAW R2. No change other than language cleanup	Language cleanup by Riki
Reflex decided on Analyzer	Scenario to be re-engineered with regards to LAW R2	François does the re-eengineering. Laurent checks with Ed that some Analyzers may never perform any reflex test. For instance an analyzer performing always the same panel.
Reflex decided on AM	Useless scenario (simply a new AWOS). To be discarded.	Anne-Gaelle removes it.
Rerun decided on Analyzer	Scenario to be re-engineered with regards to LAW R2	François does it.
Rerun decided on AM	Useless scenario (simply a new AWOS). To be discarded.	Anne-Gaelle removes it.

All actions above to be fulfilled, with results shared, before next IHE LAB committee conf call planned for November 12. The language cleanup action is taken by Riki.

Incentive programs and certification of Healthcare information systems

Presentation of the US “Meaningful Use” incentive & certification program

Slides presented by Riki Merrick: Meaningful Use US

Discussion:

• The targets of the incentive are the care providers, using EHR systems (in hospital or ambulatory space). A voluntary meaningful user must:
  • Use a certified EHR system,
  • Meet the core objectives and at least five “menu” objectives,
  • Report quality measures.
• A lot of the program relies on a selection of interoperability standards and implementation guides (e.g.; consolidated CDA).
• LIS not part of a hospital and their users are out of scope of the program. Yet, the program requires their due capability of exchanging data with the EHR-S, following the selected standards.

Presentation of the France “Digital Hospital” incentive & certification program

Slides presented by François Macary: Digital Hospital Program France

Discussion:

• The targets of the incentive program are the (private or public) hospitals. It is also a voluntary program. To be eligible to the program a hospital must:
  • Acquire certified IT products ;
  • Fulfill the prerequisite objectives ;
  • Select one or more “Functional domain” objectives ;
  • Measure and report periodically the corresponding indicators.

LAB committee meetings and conference calls

• Conference calls monthly, 5-6pm Paris time.
  • A month in advance, we can adjust the time of the conf call if some IHE LAB members from Japan want to participate.
  • Next one set for November 12th. Agenda:
    • Approval of minutes of face to face meeting in Tokyo
    • LAW testing scenarios updated (from action items above)
    • LAW testing at connectathons: Japan (October 2013) and North-America (January 2014).
    • Discussion on where and when for next face to face meeting (see below)
• Discussion on next face to face meeting:
  • Mary Kennedy had proposed Deer Field after the January connectathon of Chicago. But this is too close to the current meeting.
  • Next meeting will more likely be held in Paris at ASIP Santé, in May. After discussion of various time constraints (including an event in Japan), the more probable period for this meeting in Paris is May 20 to 22. A possible second choice is May 12 to 14.