Lab f2f Paris May 2014 minutes

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Day 1 Minutes- May 12, 2014

Welcome (Carolyn Knapik- CAP)

Introductions (All)

IHE Lab Overview (Francois Macary) File:LAB Paris Opening FM.pdf

Agenda Review (Francois Macary) http://wiki.ihe.net/index.php?title=LAB_F2F_Paris_May2014

LAW Discussion Looking at Figure 3-1: Have not focused on the fact, if LAW is good at covering middleware to Lab Analyzer Manager or other middleware- to possibly LTW; Beckman Coulter has tested LAW between middleware to analyzer manger to manage multiple instruments; MIPS had issue with the fact that the Analyzer Manager must be able to support the two methods of the query (by specimen ID or by specimen position on the analyzer): LAW has communication about specimen and specimen location, depending on feature where middleware located – barcode labeled specimen vs using position of specimen on plates – use SPM or SAC segment to communicate – not needed in every discipline in lab – in hematology use the barcoded container; LAW on its own does not distinguish between label as well as position – this profile should allow option to chose either barcoded containers or position identified specimen (from analyzer manager viewpoint); Some analyzer managers are specialized for only one – would this be possible to consider as an option in LAW? – New CP!; Biomerieux will submit a similar CP – part of the discussions on how to test for options at connectathon; Adjust publication; LAW – experience in exchanging messages using multi-character sets?; Japan is using 3 character sets – Japanese industry standard; Unicode and micro code set? (see slides from Naomi’s presentation); Declare in MSH-18 – would like a bit more implementation experience with this feature; LAW requires UTF-8 – national extensions are allowed; MSH-20 allows to communicate an alternate character set; Looking at Ed’s slides to introduce LAW background and introduction to IICC. IICC Tech Status CPs for Trial implementation to be published in Oct 2014; Options where instruments can be creator of patient demographics – how to deal with that, since LAW does not cover being an entry point for orders, with all that patient demographics; ATM1391 and ASTM 1394 = now CLSI standards – idea is LAW to be a successor to LIS 1 and LIS2 style interfaces – Informatics Committee is the sponsoring CLSI body; IVD vendors, federal governments and healthcare providers (lab director hospital, educational institution) – more participation from US, but it is an international SDO for the last 8-10 years; The document development committees have minimal requirements for participation – hospital, IVD vendors, international etc.; They also have an approval process involving CLSI membership and public comment (1 or 2 periods); What about ISO endorsement? Don’t think CLSI currently has that as a goal – don’t think ISO has separate standards development ongoing for this topic; CLSI has the Laboratory Automation Standard – references HL7 Chapter 13 – expect the same to happen for LAW profile; Testing strategy to expand past connectathon testing using the tools used at IHE connectahon; IHE USA has started certification process for specific IHE profiles – in certification roadmap to 2016 LAW is not included at this point – working on getting included; IHE connectathon overview – will add 2013 EU connectahon and Japanese 2013 – 1 analyzer and 3 analyzer managers – will see in afternoon; WHO is very interested in sending list of standards to recommend for implementation tight relationship with ISO – consider reaching out to WHO eHealth initiatives – timeline is 9 months to get this developed

Coffee Break

Open Items from CP (additions to OBR segment) Expand OBR-16 to allow as O fields; Required is OBR-16.1 = ID number consider the use of assigning authority, if the analyzer manager just passes on information from outside - we assume NOT, the analyzer manager is responsible for managing IDs and prevent collision of IDs; Should we provide guidance on when to use assigning authority with the ID – possibly at a different level; OBX-29 new field in v2.8.1 to include type of result – make Mandatory for LAW; Special in LAW – has to be populated – is similar to the R in HL7 and if it is missing MUST cause an Error (stronger than R in HL7, where it can also be ignored when missing) – for all M elements will give guidance if Nullflavors are allowed; Any new values for HL7 table; AOE – vs SCI – solicited answer vs unsolicited answer – may not be important for the analyzer to be differentiated; Consider adding a paragraph about pre-adoption to LAW

Lunch

IHE Lab Profile Deployment Reports Japan- see slides File:IHE-J Lab2013-2 Naomi.pdf and File:IHE-J Lab Ken Iguchi.pdf USA: LAW, XD-Lab have been tested at NA Connectathon Europe- see slides LTW LAB-1: workflow dependent for implementation, even if supported in the message – harder to implement than LTW LAB-3; Implementations bring up questions; Where to send SPM, to repeat or not to repeat; How to report interpretations on the susceptibility, when you don’t report actual results?; Must have description for codes of local systems?; How to report Isolation testing – for example beta-lactamase activity? LCC(Jim Harrison) File:LCC IHE May2014-Paris-3.pdf Wouldn’t it make sense when RC is sent to include the filler order number already?; Depends if the filler system wants to create and maintain the ID for recommended orders even when they are declined. Discussion still to be had once profile published for larger feedback; When Filler sends back the accepted order use IP as the order code; If the recommendation expires, then the filler will revert to the original order, that will be handled; How do we track the declined replacement orders when they don’t have any numbers to reference – do not send back, if not accepted – good catch.; Could we use ORC-4 to group the replacement orders together? ORC-4 may already be used to create the requisition, so not necessarily available; Intended to work on orders on the same message; What OBR-25 status should we use in the Hold for review instance? Consider replicating the HR code for OBR-25 as well.; Fulfillment request: REL-2 = relationship type REL-3 = Identifying the source order in EI REL-4 = Identifying the target order in EI EI is problematic for Lab order, which uses EIP to support placer and filler REL-4 could use ORC-4 when follow up on all orders in the group are needed / OBR-2, when all results under one order are referenced / OBX-21 when referring to a specific result What about the prior order group? Only needed for send to third party review. In the proposal for adding REL – we should include taking out the other fields that are listed in the ORC and OBR segments (ORC-8, ORC-50, OBR-26, OBR-49) add parent order / parent reflex There is a request for making ORC-8 repeatable in front of HL7 OO (see Dmytro’s email from 3/3/2014) – should consider together with the REL proposal! The fulfillment order is NOT related to specimen – so do we need to add the REL segment to all the OML message structures, or just to the order centric. May need to adjust planning of LCC publication based on the feedback we get from HL7. How would this use case be handled in FHIR? Need to decide if this use case is ONLY in the 80 % rule if so, then could consider. Feedback from the French WG on microbio vocabularies (Xavier Gansel)File:IHE Xavier May 12 2014.pdf Sylvie is in charge of translating LOINC to French; Add arrow to workflow reporting to PH: From LIS to PH; Do we need to add information to the patient?; In France they have a national health record that is accessible by patients – structured data to professionals only otherwise. Diagram is not representative of all flows. Review of new supplement proposals, and selection (Riki) Further discussion on LDA:File:IHE LAB LDA Presentation.pdf What is the deliverable for this project? Update to LDA, or new interactions to be added to LDA? Currently LDA covers the automation and analytical workflow. Analytical workflow has now been replaced by LAW Pre-or post analytical device – de-capper, aliquoter etc includes status change of the performed step (SWOS) There are other interactions in the pre-analytical/ post-analytical steps: Sample routing for example – need to handle custody of the sample between the track and the analyzer – analyzer draws specimen, then can return to tracker for further steps Should this be part of LDA or become a new profile? LAB-21 (analyzer location can be a parameter in this WOS) and LAB-26 (status change). GLMIS has implementation projects for automation manager: individual instances of analyzers are managed by GLIMS Specimen scanned – AM gives instructions on what to do – 2 options: aliquot or send to analyzer (in sequence, if more than 1) – send to analyzer – LAW – return to track – rescan: options: aliquot or send to analyzer or hold or archive Do we need an intermediate step of “ask analyzer, if ready to perform this test before routing? Not sure this one is covered already. Sounds like re-engineering the LDA profile starting at the use case level – currently only have simple steps described This use case may need additional parameters beyond what is currently supported. Also need to describe interactions between LDA and LAW and if LAW is responsive to the new use cases. Ed’s additional LDA slides about Lab Automation Manager Consider if the Analyzer Manager and Automation Manager should be linked – seems to be more independent. – Or there is a variety of existing implementations Also not necessarily the order filler as the only source for this – would use LTW for this to get information to the analyzer manager / automation managers LIS report status of the test order without results (LTW) – possibly use this for the status update messages in LAW

Open Discussion Support for the project from Beckman Coulter (discussed at NA conntectathon) and here GLIMS, Roche, Biomerieux and Inpeco Trying to find out if Japan has interest in expanding LDA and possibly using other Chapter 13 messages.

Meeting adjourned 5:15 PM