PaLM Conf Minutes 2018-Mar-14

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The recording for this meeting can be downloaded here


Raj Dash, Co-Chair CAP
Riki Merrick, Co-Chair Vernetzt, LLC
Carolyn Knapik CAP, secretariat
Mary Kennedy CAP, secretariat
Alessandro Sulis CRS4
Daniel Rutz Epic
David de Mena SAS
Francesca Frexia CRS4
Francesca Vanzo Arsenal IT
George Birdsong CAP
Gunter Haroske IHE Germany
James Harrison CAP
Jessica Poisson Duke
John David Nolen
Joe Suintrapun
Mario Villace Roche
Megumi Kondo Sakura Finetek Japan
Nick Jones MGH Harvard
Ross Simpson CAP


Agenda Reviewed and adjusted for content

Agenda link:"


First Hour:

June F2F Planning:

  • Save the date June 18 – 20, 2018 in Northfield IL (Chicago):
  • List of nearby hotels with preferred rates on link.
  • O’Hare International is the closest Chicago airport to the CAP Headquarters.
  • Please RSVP via link.
  • Remote teleconference will be available to those unable to attend in person.!topic/palm/9mc_YmII-2g


Digital Pathology Meeting in Helsinki




LCC comments:

  • Row10 comment = line 603 of document:
    • Recommending replacement orders, but this is not a real order, so some of the fields cannot be filled in in the same way, so review the usage of the fields.
    • Does not have placer OR filler order number – when it is accepted by the placer, it gets assigned the placer order number – when using ORC-1 = RC = when it is used ORC-2/OBR-2 and ORC-3/OBR-3 both are expected to be empty – can we add this text just to the LCC or also add to base?
    • Would the order number remain the same?
      • Depends on how the system handle it – it will need to be tracked as a new order, but could potentially retain a (non-public) order number
      • In LCC first order gets canceled and it is replaced by second order
      • Sample information is being sent back with the replacement order, when there is enough specimen available to do the replacement test, else there is a need to re-collect for the placer
      • Let’s ADD the text to the LCC code table
  • Row 11 = line 605:
    • Add clarification: for recommended order message the ordering provider / ordering facility SHOULD be empty
  • Row 12 = several
    • There was a discussion about the addition of a use case:
      • In AP performing a reflex chain of testing, have set of slides that then require other tests based on the results from the slides.
      • Sending out the reflex orders as part of the LCC – create supplement orders and send those back with a different control code (may be SU or something) alongside the original order.
      • If we don’t do that, then pull use case #9, else go ahead.
      • There is already a reflex order that can be ordered and no specific intermediate orders ae exchanged; in the result the parent child linkage explains where additional order_observation groups come from = this is for defined algorithms.
      • How can we deal with the phone add on order in LCC?
      • When the provider does not know which specific test needs to be ordered – the provider can ask the lab and the lab can add on a supplemental order, which could be signed by the provider to make the order official.
      • Raj, Dan and Nicholas all think this would be helpful to add now (CSF follow on flow cytometry – especially when there is limited sample would be helpful) – this will also help how often this happens (improved QC).
      • Currently the pathologists are allowed to countersign in some organizations, so that there is not a separate order created – would be good to create the electronic order trail which will help with order tracking.
      • This is for supplemental orders – the recommendation will NOT have an ordering provider nor a placer order number, so the placer system has to be based on the previous order and routed accordingly.
      • Cannot use LCC when the lab is aware of a patient but there is no available adequate specimen / previous order.
      • This is almost borderline decision support, similar to the imaging world where there are checks for appropriateness, when the system suggests replacement orders and should be mentioned when we write this requirement.
      • We can define the new order control code in the LCC and submit to harmonization for inclusion in the next cycle June 2018?


Digital Pathology White Paper:

  • Looking at the use cases – Gunter’s suggestion to group by FULL workup of all slides for primary diagnosis vs work up of a specific slide for use in X – this will be a good approach and there are differences in the workflow.
  • Need high level paragraph with overview for all use cases, for some we may provide more detail.
  • Present one or two clear examples (not prescriptive to current technologies).
  • Move some of the details into the discussion section to cover the variations / current issues.
  • Use case for QA and QC:
    • The detail is helpful for IT folks, that don’t have the pathology background.
    • Pull this out into a standard workflow section instead of having it in the use case.
  • Have a current and desired AP workflow section, so we can focus the use cases on actors and technical transactions we need.
  • Nicholas created the discussion wiki here:
  • Wiki access requested for Gunter, Dan, JD, and Laurent Duval – email will come from automated system; also can send text.
  • Assigning use cases:
  • Review authors for use cases
    • Use case #4 and #10 seem similar;
    • Raj will cover #2 and #11;
    • Nick will cover #1;
    • JD will cover #5.
  • Will need to probably re-organize the use cases and consolidate; after we get use cases lined up, define a glossary for the digital assets covered by each one.
  • Goal is to have text for each one and add details to discussion by next PaLM call in April.


Second Hour:


  • Dan has incorporated several comments, some are for future consideration.
  • Open issue #2 – taken care of by requiring documenter and filler repot the suspected reaction versus confirmed reaction – how do we indicate suspected versus confirmed – add to diagram.
  • Retain adverse event consumer as an actor.
  • #6 Added whole blood to scope.
  • #7: Query function for last minute double check – is unit still assigned, appropriate, etc.; there may be other times to have this query for appropriateness (e.g. at time of dispensing workflow) – but currently don’t have a good idea how to do this and will cover with CR in a later release.
  • FHIR resource and decision support workflow not yet well defined there. Need to wait a year or so for more development in this area.
  • We assume there is an assigned unit for patient (unit number and code – checks if scanned unit is assigned to the patient) – that is all we check – BUT not go back to lab to see if there were changes.
  • How to we identify patient derived blood products (exclude pharmaceutical) – what about stem cells?
  • In general we talk about whole blood and products derived from whole blood (liquid and patient derived).
  • Suspected reaction comes from blood transfusion documenter.
  • Blood filler reports the confirmed reaction.
  • How would a non-reaction be confirmed? Send LAB-76 with no reaction => still need to get a better definition for the LAB-76; could this be handled by using a result message – this is similar to medication / immunization / allergic reaction.
  • There is adverse event resource in FHIR (still being worked on – anything that is undesirable to patient or official report to FDA in the US) – it really should be anything that is not desired by the patient.
  • Riki thinks FDA is using v3 messaging for adverse event reporting – Riki will check with Lise Stevens.
  • Maybe publish LAB-70 to get it out to the world for comment and then expand to LAB-76 at a later time.
  • Goal is to get this to public comment due date by next meeting in April.


NEXT MEETING is rescheduled to April 4 – Mary to send out updated invite.