PaLM Conf Minutes 2019-August-14

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Name Email
David Beckman
Raj Dash
Gunter Haroke
Nick Hasselhorst
Ralf Herzog
Mary Kennedy
Megumi Kondo
Francois Macary
Riki Merrick
Kevin Schap
Alessandro Sulis
Rob Wilder
Eddie Albert
Francesca Frexia
JD Nolen
Dana Marcelonis
Ian Gabriel
Dan Rutz

Next call is September 11, 2019

F2F Meeting at CAP headquarters

Digital Pathology Profile and White Paper

  • Digital Pathology:
    • Supporting OBX/SPM as well as OBX/OBR
    • OBX/SPM required, if the stain name MUST be OBX/SPM, then there must be at least 1 OBX/SPM to cover that, since that is a DICOM required element and clearly related to the specimen
    • Where does the study UID go – ask David Clunie if OBX should be after SPM or OBR, and, who assigns that (the original submitter / the placer of this scan order (LIS / IA manager?) / the modality)?
      • Is a Series instance UID needed? Or, is it the same as placer order number? No, because we are talking to the scanner – that is for each scan – series is more the order from the placer to the lab, not from the lab to the scanner – so would that be ORC-38?
From HL7 v2.9: ORC-38 Filler Order Group Number (EI) nnnnn
Components: <Entity Identifier (ST)> & <Namespace ID (IS)> & <Universal ID (ST)> & <Universal ID Type (ID)>
Definition: This field contains a unique identifier for the Order Group as referenced by the Filler application. An Order Group is a set of orders grouped together by the placer application.
The first component is a string that uniquely identifies all order groups from the placer application. A limit of fifteen (15) characters is suggested but not required.
The second through fourth components constitute a filler application ID identical to the analogous components of ORC-2-placer order number or ORC-3-filler order number. Order groups and how to use them are described in detail in Section 4.5.1, "ORC–Common Order Segment."
      • Need to update the mapping spreadsheet but it is still be good to check with David Clunie.
    • Cancellation from the Scanner – how is that done? Can we get a real world example from Nick for that? The technician realizes the wrong batch is being scanned and pushes cancelation button.
      • In LAW can the analyzer send a cancelation? Send LAB-29 with the status as order completed and observation status as X or N – that would be at the order level so using the OBX does not work here so well
      • OBR-25 = X
      • ORC-1 = OC (for filler applications, so that should work, since that is te same is
      • ORC-5 = CA
    • Raj will create a google doc with the list of questions and answers


    • We need two events to distinguish collection performed (S39) from collection failed (S40) sharing the same message structure SET_S38; we need two events to distinguish procedure step performed (S51) from procedure step failed (S52) sharing the same message structure SET_S51.
    • We need a distinct event (S50) and message structure (SET_S50) to track the derivation of a child specimen. The derivation of a child specimen is always a success.
    • For consideration:
      • When a specimen is processed to produce a derived (child) specimen the events tracked are:
        • 1 S51 (procedure step performed) on the input (parent) specimen;
        • n S50 (child specimen derived) for each child specimen produced;
        • When the derivation process fails, the single event tracked is:
        • S52 (procedure step failed) on the input specimen


      • We were having lengthy discussions about what processing produces a derived specimen and what doesn't - there are some clear examples:
        • culture -> isolate(s)
        • organ -> block -.> section -is really -> slide
        • sample -> aliquots (this is really just a splitting of the same sample across multiple containers, but then if the containers have different additives, they alter the specimen)
        • slide -> digital image
        • pooling multiple samples into one is less clear
        • centrifuging and using only the plasma / serum (if that was the intent of the blood collected in the tube with appropriate additives?)
      • Per Riki: the difference between a successful processing step and a derived specimen is the inclusion of the information about the derived specimen, right?
  • Are there advantages of having parent specimen and child specimen in the same message?
  • Options are:
    • #1 Use S50 for any processing successful message, with optionally reporting the derived specimen
    • #2 Use S50 only to declare the derived specimen (no information on the parent specimen other than SPM-3) and then use S51 for successful processing of the parent specimen
  • We need a message structure to report unsuccessful processing events, but need to examine if that message structure is at all different from the successful processing event.

PCD Joint Work

    • Rob Wilder, from Spoc, and part of the PC domain (planning Co-Chair)
    • ACM management working group = alerting
    • Mobile desktop managing for patient workflow in EHR-S
    • Lab and radiology alert managers – providing notification to docs to mobile devices, when results are ready, would like to standardize that
    • Successful implementations have reduced response times in result reviewed by the physicians
Link to PCD White Paper:
    • The PCD white paper with this group – looking for input around the described actors
    • Want to promote use of the CD profiles and PaLM profiles for best implementations and to try to get this as joint Connectathons across domains.
    • There was a problem previously with endpoint communication devices in prior – adopted WPCT – extended that protocol
    • Added prioritization of URL
    • Enable lab systems remote readers and automate accessing radiology image on mobile devices
    • There is a need to be more specific of what to send alerts about vs creating a digest of bank of tests ordered
    • ORU^R40 – used for initial notification
    • There is a Radiology profile called MACM, but it was never adopted. ACM is widely adopted – working with radiology to migrate over to that
    • Some of the alerting is used for the dashboard in the EHR-S
    • LOE for this project? Need the domain expertise to make this successful ORU^R40 vs ORU^R01…
    • Maybe see if LIS can implement PCD-04 and maybe PCD-05 (doc has seen and accepted lab results)
    • Need pathologist expertise to continue
    • Please read white paper and send questions to Rob at
    • We will discuss this on the next call in the second hour.