PaLM Conf Minutes 2023-November-08

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Ralf Herzog Jim McNulty
Kevin Schap Riki Merrick
Megumi Kondo Ruben Fernandes
Rob Rae Gunter Haroske
Alessandro Sulis JD Nolen
Roy CL Jan Schutrups
Jim Harrison Norman Zerbe
Hunter Putzke Mary Kennedy
Raj Dash Dan Rutz

Next PaLM Meeting: December 13, 2023

Agenda items:

  1. 4 CPs for approval
    • CPs for TF
        1. 268 – Result Predicate Correction in LAB-80
        • This is for OML^O33.
        • David Clunie has SAC before the SPM - which is NOT in any of the available message structures for orders in base HL7 V2 standard up to V2.9.1, so we should provide feedback to David – Link?
        • Motion to approve: Alessandro/Raj – against: 0, abstain: 0, in favor: all.
        1. 272 – CDA Battery organizer update to allow for some, but not all results being available (still pending) at the order level.
        • Motion to approve: Alessandro/Riki – against: 0, abstain: 0, in favor: all
        1. 273 – CDA Lab Observation update
        • This result is still pending; should be the description.
        • We are limited by the codes in the underlying V3 actStatus code system:
        • Use result pending as the description, to match what we have for battery level
        • Motion to approve: Alessandro/Riki – against: 0, abstain: 0, in favor: all
        1. 274 – End of patient group
        • Motion to approve: Riki/Ralf – against: 0, abstain: 0, in favor: all
      • Alessandro will make the edits and put it on the wiki. He will send the edited versions to Mary Jungers to be published.
  2. PT Profile update
    • Slides from Jim Harrison
    • Met with CAP around the data elements for the prototyping of data elements needed for PT.
    • Rename to “Performance Monitoring Workflow (PMW)”
    • We have all transactions and segments already available.
    • Duke had done some mapping to HL7 data elements – shared proposed mapping = get spreadsheet from Jim.
      • Reviewing the mappings
        • CAP number – should not use OBX-15, since that is a CWE (but it si different from the performing lab ID, which is in OBX-23.10 as CLIA number) – CAP number is a 7-digit ID assumed for PT testing.
        • ENV – should map to MSH-11.
        • KITUID – should NOT be PV1-1 – need to better understand how this is used to decide where to map.
        • Operating tech – maps to OBX-16.
        • Verifier tech – maps the OBX-16 (do we need both?)
          • You might need the operator name field for cytology specimens which are individually graded by cytotechs; same with pathologists.
        • Instrument name – need to discuss mapping OBX-17 – should use PRT.
        • Instrument ID – need to discuss mapping - OBX-18– should use PRT.
        • Instrument type – need to discuss mapping OBX-17 in LRI / OBX-18 in LAW – should use PRT.
        • Test kit ID etc also go into PRT.
        • Reagents and calibrators (not being able to be sent out from the instrument yet) – could also use PRT for these or the INV segment.
        • So far we are not using the PRT segment in IHE
          • We may not need to change LAW, since they can send the instrument data in OBX-18 and INV segments.
          • The PRT segment could also be purposed for the verifier.
  3. DPIA change proposal
    • Raj to look at SNOMED model for substances vs procedures for staining (eg, IHE vs H&E)
    • Review DICOM value set
      • SPM-6 Additives (formalin vs fresh vs alcohol)
      • SPM-4 Specimen type
      • SPM-7 Collection Method (not a stain); do not use
      • For v2, propose OBX after SPM to discuss processing steps. For now, will contain the local descriptive text.
      • How should we standardize? Could require SNOMED procedure codes but where would this information come from? Not typically stored in the LIS, only the “task name”/local name are stored).
      • For stain (eg, Ki67, ER, PR, H&E, PIN4)
        • Do not need all methodology to interpret all stains; only the final stain (eg, Ki67)
        • Some stains are cryptic (eg, multiplex stains with different chromagens, eg, PIN4); may benefit from availability of multiple metadata elements
        • SPM-6 is a coded field; CWE repeatable (not sure this will work)
        • For short term, need a more flexible field (free text) [post call Riki comment: you can use the CWE.9 for the free text, when you don’t have codes]
        • Ideally would have a SNOMED code.
        • OBX on specimen level would be more flexible.
        • Stain cocktails combine multiple antibodies (p63+AE1/AE3) – a repeatable OBX would allow for capturing this granularity.
        • OR, we only allow a single OBX with the name of the cocktail (eg,PIN4), but this might not be scalable. If this can be resolved, Raj will put into a CP.
        • Raj to mockup a complex example using SPM-6 vs OBX
        • Need to discuss with DICOM WG26. Raj will attend next DICOM call on November 21; Kevin will facilitate getting this on the agenda.
        • Raj to send his PPT to Kevin for him to post to DICOM.

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