Lab Tech Minutes 09.04.14-16

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Topics: LAB TF 3.0, 3 supplements, elections, setting up planning committee


Attendee Organization Country May 14 May 15 May 16
am pm am pm am pm
Eric Poiseau INRIA France + + + + +
Hiroyoshi Okada ITEC Japan + + + + +
Yoshimi Hirasawa Techno Medica Japan + + + + +
Shigeo Hasegawa Olympus Japan + + + + +
Karima Bourquard GMSIH France + + + + +
François Macary GIP DMP France + + + +
Ken McCaslin Quest US +
Vassil Peychev Epics US + + + +
Hiroyoki Kohda Fujifilm Japan + +
Takashi Nakashima Fujifilm Japan +
Andrzej Knafel Roche Diagnostics Switzerland + +
Shin-ichi Watanabe A&T Japan + + + + +
Genichi Kato Kyoto 1st Red Cross Hospital Japan + + + +
Alexander Mense University of applied science Austria + +
Stefan Sabutsch University of applied science Austria + +
Nobuyuki Chiba A&T Japan + + + +
Mayu Nagao A&T Japan + + + + +
Charles Parisot GE France + + + + +
Osamu Yamada Okazaki City Hospital Japan + +
Alexander Henket Nictiz Netherlands + + +
Ken Iguchi Osaka medical college Japan + +
Kazuo Suzuki Fujitsu Yamaguchi Int. Japan + + +
Anna Orlova US + +

Supporting documents

All documents used during the meeting are available in this folder on ihe ftp server


Agenda adjustment and approval

Thursday May 14:

  • Welcome, roundtable, housekeeping, agenda adjustments & approval
  • Organization: Planning & Technical Committee, cochair elections - Karima
  • Inter-Laboratory Workflow profile (ILW): goes to "Trial for Implementation" - François
  • XD-LAB project in Austria - Stefan, Alexander Mense
  • Conclusion on the Italian microbiology issue with XD-LAB - François

Friday May 15:

  • Graphs & Images in lab results (option GIR for LTW and LDA profiles) - Ken, Shini-chi, François
  • All afternoon: Content Profile for CDA lab order document (XOCP) - Alexander Henket
  • First pass on comments to white paper "External Lab Ordering"

Saturday May 16:

  • Conclusions on Newborn Screening business analysis - Anna Orlova (9:15 to 9:25 am)
  • Work plan for Order Content modules
  • Update on IHE LAB round the world
  • Planning & wrapup, estimate period and plan for next ftf - Karima

Agenda is approved Time frame of each day is 9 am to 5 pm (Kyoto time), except for last day


Presentation by Karima: Temporary Secretary
Planning & Technical committees
Cochair elections
To participate, your organization must first apply to IHE International. See apply form on Then you can participate to any domain. To participate to LAB, email to Karima. To vote you must be in the roster. The cochair election is opened until 6 pm today (Kyoto time). Cast your vote by email to Karima. One vote per organization.
IHE LAB needs a new secretary: A person whose organization is sponsoring the LAB domain. The request is opened from now to June 15. Contact Karima.

Election of cochairs: 15 voting members out of 21 eligible. Unanimous vote.
Cochairs elected:
Planning Committee: Osamu Yamada, François Macary
Technical Committee: Sondra Renly, Yoshimi Hirasawa

Inter Laboratory Workflow Supplement

Comments received: none This is a profile of interest at least for France. IHE France will have to advertise it to the IT lab community once again. Some comments addressed during the session. Among others: Explanation on the option "Report Fac-simile" and the option "Test addition approval". Decision to publish the supplement for TI, per the schedule.

Action item: François

Italian microbiology issue

See the slides "microbiology_tree"
The current restriction in XD-LAB does not come from CDA but from an alignment with the V3 Lab Result message. This constraint does not exist in V2 results messages.
The solution based on a qualifier element, either directly or through the intermediate translation element is confirmed to be a misusage of the CDA schema. So the solution will be to release the existing constraint on the entry template of XD-LAB. Two possible variations:
a) Attach the isolate cluster directly below the observation that identified this isolate.
b) Attach the isolate cluster organizer below the culture battery organizer.
In parallel, the corresponding change request for the V3 lab message shall be submitted to HL7 O&O.

Action item: François 

XD-LAB and the ELGA project

Presentation by Alexander Mense and Stefan Sabutsch, see document "XDLab_Austria_IHE_f2f_20090514.ppt"
Needs for extending XD-LAB:

  • Provide the chief complaint section and the admitting diagnosis section from PCC, as an optional feature of XD-LAB.
Action item: Build CP for XD-LAB and post it to LAB mailing list --> Stefan
  • Ask PCC to explain how to validate against the cda.xsd a document (e.g. XD-LAB) containing extensions to the CDA schema (e.g. precondition for reference range), protected by a specific namespace. Example:
<observationRange classCode="OBS" moodCode="EVN.CRT"> 
<value xsi:type="IVL_PQ"> 
<low value="4.50" unit="10*6/mm3"/> 
<high value="6.00" unit="10*6/mm3"/> 
<lab:precondition typeCode="PRCN"> 
<lab:criterion classCode="COND"> 
<lab:code code="SEX"/> 
<lab:value xsi:type="CD" code="M" codeSystem="2.16.840.1.113883.5.1"/> 
Action Item: Request to PCC --> Charles
  • The LOINC specialty sections do not correspond exactly to the Austrian classification, to the French neither.

Change Proposals for LAB TF

CPs #148, #149, #152, #153 finalized and approved

Action item: Incorporate the CPs in the future LAB TF 3.0 --> François  --> Done.

CP #150 is accepted and assigned to Joost. the committee raises one concern about the proposed solution: This one batch message may be quite big, and the acknowledgement comes after the Code Set Consumer has integrated the content. Isn't there a danger of breaking existing implementations of the communication layer (MLLP)? Also because some HL7 message connectors are based on MSH segment, and won't work with a message starting with BHS.

  • Consider coupling the batch with the continuation protocol of HL7, to split the big chunck into smaller units.
  • Consider an alternate solution sticking to the existing sequence of 4 messages M08, M09, M11, M10, in which each message is systematically present even if it is empty because there is no object of that category in the code set.
Action item: CP To be finalized, with the rational --> Joost

External lab order Supplement

Presented by Alexander Henket
Pub/Sup on XDS mechanism underway for 2009.
Need new type of relationship between documents "SUCC" (successor) Also consider SubmissionSet to tie documents together (e.g. lab order + phlebotomy report)

RCMR not suited to convey status. ActStatus discouraged by Vassil Peythev. Points to Order messages to convey status.

The discussion appears to be too difficult to pursue for this afternoon. Will continue discussion on content. Workflow will need more attention.

Index if containing document links can only track status on the document itself. Only when you index act (e.g. order) you can track the status of that.

In Japan a repeating order does not exist. If you want a test to be done multiple times, you need to create as many orders. In France there is a repeatable order/renewable order on paper.

CCD or XDS-MS Referral contains lots of modules related to the patient summary that we would require to supply to microbiologists. Consider looking at these and even consider creating a separate summary document that you attach to the actual order. The alternative to that is combining the summary information inside the order. This would make the order relatively big. Considering privacy we could say it is better to separate the professional summary bit from the order bit.

Charles is worried about the level of detail. Too fine grained data items runs the risk of not getting adequate implementation. Franois agrees with Charles that the document coming from the GP does not need a lot of detail regarding the specimen, whereas the report from the phlebotomist would need.

Franois references microbiology use cases that we did before the white paper, but did not make it into the white paper. These might contain more justification for all the fine grained detail in the specimen collection report.

France has workflow that takes you from GP, to Lab, to Phlebotomy. Netherlands has workflow that takes you from GP, to Phlebotomy, to Lab. It was established that the proposed would still work for both, just in a different order.

Next steps:
1. Continue work on refining the data requirements document
2. Create a skeleton of the various CDA section templates and structures that are needed for the various types of order. 
2.1 Clinical history
2.2 Clinical Chemistry order
2.3 Microbiology order
2.4 Clinical Chemistry specimen
2.5 Microbiology specimen
 Action items:
 Create a one page document for 2.1 - 2.5 
 to outline the proposed mapping to CDA
 Have two conference calls before June 30

GIR supplement

Presentation by Ken Iguchi and Shin-ichi Watanabe
Complements on the specification:

  • Image maximum size and category (image or graph) to be added in the table appearing in vol 1.
  • The format of image has to be precised and restricted:
    • jpeg, png.
    • jpeg

The image size is between 10 and 100 KB
Check the use cases regarding the number of images that can be mentioned in one ORU / OUL message. So far it seems to be no more than one image per message
Discussion on the 3 mecanisms to carry this image (NA, ED, RP). RP "Reference Pointer" is the most difficult to deal with by the receiver: The URI scheme has to be precisely specified, and there is in this case a need for additional configuration on both systems (e.g. setting an http server on the sending system if the URI is http://aaaaa...). 3 options are to be considered on the link between device and AM (transaction LAB-23):

  • Keep only ED for simple images, and NA for graphs(e.g. electrophoresis chart)
  • Keep NA for graphs, and ED & RP for simple images, but limit the URI scheme of RP to http GET.
  • Keep NA for graphs, and ED & RP for simple images, but limit the URI scheme of RP to a reasonable short list: http GET, ftp
Action item: IHE LAB Japan will discuss these issues and come back with a refined proposal.
Updated supplement posted to LAB mailing list on June 10
Review by members of technical committee for June 20. Reviewers send their comments to IHE Japan
IHE Lab Japan resolves the comments and posts the Public Comment version to the mailing list
François publishes the supplement on for public comment
Public comment period: July
IHE Lab Japan expects to test this option at the October connectathon

NBS white paper by IHE QRPH, including contribution from IHE LAB

Presentation by Ana Orlova

Ana presented spreadsheet Newborn Bloodspot Screening Data Concepts Mapping.

  • Mapping of concepts between USA (5 states) and 3 European country (France, Austria and Germany).
  • Presentation of the workflow : Newborn Bloodspot Screening and Newborn Hearing Screening which is presented in a very similar way as the NBS.

Will be publish as a public comment on the 4th of June in QRPH domain. Public comment period is one month.

What are the specific points to be considered by the lab committee reviewer ?

  • Uses the lab terminology. How does the lab order map with the NBS.
  • How to standardize the lab results dataset

White paper will be presented to HISTP.

Form from other country are welcome. Alexander to search and provide the Netherlands form.

Read the paper during the public comment and provide comment.

Planning for current supplements + LAB TF 3.0

Specification CAT Japan (26/10/2009) CAT US (January 2010) CAT Europe (April 2010) CAT Australia (July 2009) publish/Init
Main editor
ILW (for Trial Implementation) + 05/06/09 JC Hassler
XOCL (for Public Comment) + 31/07/09 A Henket
External Lab Order (WP) NA NA NA NA 30/06/09 A Hamster
GIR (for Public Comment) + + 01/07/09 K Iguchi
Taskforce Lab Community WKF NA NA NA NA 28/05/09 (T conf) F Macary
LAB TF 3.0 + + + + 05/06/09 F Macary

Teleconférences planned :

  • WP : 1/06/09 4pm CET (Paris) 2hours
  • XOCL: data requirements 15/06/09 4pm CET (Paris) 2 hours
  • XOCL: content profile 22/06/09 4pm CET (Paris) 2 hours. First draft available on 30/06/09 for first review by experts.
  • taskforce : 28/05/09 4pm CET (Paris) 1 hour--> initialization of the taskforce. The object is to produce a white paper on management of the WKF related to the document sharing. This WP need to be drafted for the next FTF meeting.

The face to face meeting is planned in 30/09-01/10-02/10 in Chicago or New York in order to solve comments on the supplements and the WP.

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