PCD PIV 2009-05-19 F2F
Meeting Purpose
Discuss and resolve issues related to standardization of infusion pump information. See the PIV Current Issues Discussion wiki page http://wiki.ihe.net/index.php?title=PCD_PIV_Current_Issues_Discussion for details.
WebEx Information
This is a face-to-face meeting (no WebEx support).
Location
The meetings will be heald at Cardinal Health's Corporate Headquarters:
- Cardinal Health
- Corporate Headquarters
- 3750 Torrey View Court
- San Diego, CA 92130
- 858.617.2000
- 888.876.7128 (toll-free)
Current Issues
1. When PIV is used with DEC to support the reporting of the status of a infusion, the order ID (Placer Order Number) provided in ORC-2 (PCD-03 transaction) should be contained in the PCD-01 message - Currently PCD-01 allows for a single Placer Order Number in a message; however, an infuser may have different infusions programmed and/or running at the same time on a single channel. We need to support Placer Order Numbers in a PCD-01 message.
2. Revisit pump model to account for a means of identifying the running channel
3. Revisit pump model to account for events (e.g. piggyback completed)
4. PCD-03: RXG-17 and 18 (Give Strength and Units) and RXG-23 and 24 (Give Drug Strength Volume and Units) are used to determine the concentration of the drug as defined in the pump drug library. Since not all drugs are defined with a concentration, these fields should be conditional instead of RE. We need to define the condition.
5. Determine whether there is a way to include programming for syringe pumps (such as pump type, syringe size and manufacturer) in the current PCD-03 transaction
6. Develop a document for use by the HL7 group which identifies enhancements to the HL7 standards that are needed to support ordering and administration of medications using syringe pumps and PCA pumps.
7. Revisit the acknowledgement message currently defined as original acknowledgment format but uses enhance acknowledgement application mode fields.
8. (added by Ruth from GE) The universal service sent in OBR;4 in the PCD-01 message (ORU) should match the give code sent in the give message. In other words, the service being administered should be what was requested. The codes sent in current ORU's seem mean to identify that the service is a pump but they should identify the drug.
9. (added by Gary Meyer) Discuss the construction of and components in the OBX segment with regards to PIV reporting.
Proposed Agenda
Tuesday May 19
8:30 – 12:00
- Introduction
- Agenda Review
- NIST test framework review and objective
- ECRI perspective on key issues for pump interoperability
- Key elements of 11073 infusion model
- Summary of draft infusion spec
- Issue 1 (PDC01 modification to support multiple OBRs)
- Issue 4 (RXG 17,18,23 and 24)
1:00 – 5:00
- Infusion model mapping to MDS.VDM.Channel.Metric
- Issue 2 (OBX 4 and 18)
Wednesday May 20
8:30 -12:00
- Continue with discussion from Tuesday if needed
- Issue 5 (Syringe)
- required message elements
- new message needed?
- Issue 6 (PCA)
- required message elements
- new message needed?
- Issue 3 (Accounting for infusion events in infusion model)
- Rosetta pump terminology gap review (modes, status, etc)
- Use of ORU vs RAS message
1:00 – 5:00
- Issue 7 (ACK model)
- Issue 8 (Universal ID)
- NIST Test scenarios
- MWB PCD-03 Profile
- MWB PCD-01 Profile
- MWB PCD-04 Profile
- Issue 9
- Infusion pump/eMAR workflow terminology parameter gap review
- Wrap up and next steps
Attachments / Materials
Discussion Notes
Participants
- Chair/Host: Jeff Rinda (Hospira) & Khalid Zubaidi (Cardinal)
- Ruth Berge (GE), Shantanu Chawla (Cardinal), Todd Cooper (BSF), Jeff Dern (Cardinal), Al Engelbert (B.Braun), Fred Ehrhardt (Capsule), Colin FX (Epic), John Garguilo (NIST), Janet Ireland (Cardinal), Brad Lunde (Cardinal), John Martinez (Cardinal), Gary Meyer (Cardinal), Erin Sparnon (ECRI), Kristina Wilson (Hospira)
Action Items
- NOTE: The items in the table below are not in priority order - they are in the order of the discussion during the F2F meetings.
Number Action Owner Participants Due Date Status Comments 1 Enterprise PnP Discussion Topic Cooper PCD TC & IHE DCC 2009.07.01 OPEN During Garguilo's NIST update , the topic of expanded "lower layer" coordination (beyond the HL7 MLLP * ) was brought up as a key area in which to engage. This is similar to the "enterprise plug-and-play" or discovery capability that Jan Wittenber presented during the recent F2F meetings at NIST (Friday, 2009.05.08). Todd will (a) add the discussion topic to the IHE domain coordination committee's list; and (b) add it to the PCD discussion topics list. Note: this may result in additional profile proposals for consideration in the fall. - * "MLLP" = Minimal Lower Layer Protocol; a "minimalistic OSI-session layer framing protocol"; see HL7 documentation, including [1]
2 PCD MWB Message Profiling Methodology Ioana Garguilo 2009.07.01 OPEN Given the number of PCD transaction messages targeted for registration and how that will be used in the PCD profile testing framework, a common methodology, set of principles, or template should be established to ensure consistency between the message formalizations and to ensure that they will be fit for purpose. 3 FDA Engagement Strategy Cooper Sparnon 2009.07.01 OPEN During Erin's ECRI presentation, she stressed education including the FDA. It was clear, though, that their contacts and entry points are different from those of the PCD group. This action is to compare notes and make sure that we are inviting and engaging the right set of participants and to see if there is additional information that can be provided or events that can be hosted. Todd mentioned that the FDA has also reached out regarding medical device informatics standards and understanding how they may be incorporated into the regulatory framework. Also there is the deferred "regulatory considerations" white paper that may be considered as well. 4 HIMSS 2010 Education Session Proposal Sparnon Meyer, et al. 2009.05.29 OPEN Erin is developing an educatitonal session proposal for HIMSS '10 and solicited support from group members to help complete the proposal. - Status Update: Info provided to Erin; submission made to HIMSS (deadline 2009.05.29); pending acceptance of proposal, the WG will provide additional support as needed / requested.
5 Extend Call for Participation Cooper Sparnon 2009.06.15 OPEN Erin will provide additional infusion pump companies that Todd can contact and encourage to participate. 6 Work flow-Based Scenario Document Discussion Rinda PCD PC 2009.07.01 OPEN There is a need for better coupling of workflow usage (profile) for a given set of PCD & IHE profiles (possibly, a workflow-based use case scenario document (e.g., if you want the infusion start time, look at this OBX field XYZ...)). It could be a document that is organized according to clinical workflow/use cases. - This should be added to the IHE PCD Planning Committee discussion agenda.
- May be implemented as a registry of ICE-PAC-esque clinical workflow analyses.
- NOTE: Information provided by Rinda to Sparnon re. HIMSS presentation proposal is an example of the potential document content.
7 CP for ORC-2 Berge / Meyer PCD TC 2009.06.22 OPEN Ruth & Gary will draft a Change Proposal for ORC-2 (PCD Technical Framework vol 2. p. 48, lines 8-20) that will address: - Update the text to reflect that ORC's are now used (e.g., in the PIV profile).
- PIV does have a Placer Order that can be associated with the PCD-O1 stream.
- Ensure that the "standing order" scenario is addressed (e.g., for a gateway implementing the DOR/DOF actors).
8 Multiple OBR Support Rhoads Berge, PCD TC 2009.06.15 OPEN A single infusor can accommodate multiple orders (one per OBR) at the same time. Need to choose: - 1. Multiple OBRs per PCD-01 update
- 2. Add an Order # semantic in the Source Channel data set, that can then be reported explicitly as an OBX segment.
Determine issues & conventions (e.g., within IHE) around the use of OBRs and multiple OBRs per message. For example, to report operational status snapshots across all infusion channels.
9 CP for Required RXG Fields Rinda PCD TC 2009.06.15 OPEN Draft a Change Proposal for PIV that RXG-17, -18, -23 & -24 are required for a specified class of medications. Note that the "Give Code" refers to the medication ID for the infusion pump - many pharmacy systems only pass medication ID (i.e., what is scanned from a infusate bag).
A key issue is that "RE" implies there is a condition when it can / cannot be valued. Problem is that the value typically has to be retrieved by the BCMA system - and is usually not automatically provided.
10 EUI-64 Compliance for 2010 Connectathon Rhoads PCD TC 2009.07.01 OPEN The IHE PCD Technical Committee has to determine ASAP the level of required compliance for usage of the EUI-64 identifier by profile implementations going forward (e.g., for testing in the 2010 Connectathon). This should be added to the TC (and PC?) agenda, open issues / TF clarifications identified and CP's - if needed - submitted and balloted.
- NOTE: Schedule WebEx discussion 2nd half of June.
11 Infusion Pump Model MindMap Cooper Rhoads, I/P WG 2009.07.01 OPEN Develop an updated version of the infusion pump device specialization information model, based on the ISO/IEEE 11073-10201 domain information model, that can provide a template for application to: - Specific infusion pump configurations
- ICS Generator "template" file and device-specific versions
- PCD-01 OBX-4 valuation & sequences
- Event support (incl. pump state transitions + alert/alarm events, both for archival (DEC processing) & annunciation (ACM processing) & PoC annunciation (DPI processing).
- NOTE: Schedule a review in July.
12 Syringe Pump Semantics Cooper / Rinda Schluter, I/P WG 2009.06.15 OPEN Establish a set of syringe pump semantics. - Coordinate with infusion pump model (see above)
- Coordinate with the Rosetta tables
- Identify additional syringe pump events
- Determine whether syringe type & size is needed (e.g., by EHR systems) and whether it is provided by any syringe pumps and / or from pump servers.
13 CP for RXR-3 Rinda I/P WG 2009.06.15 OPEN Update PIV specification for RXR-3 to: - Support "RE" instead of "R"
- Support "syringe"
14 I/P CP Wiki Rinda CP Owners 2009.06.15 OPEN Create a wiki page to capture and discuss PIV-related Change Proposals. 15 PCA Semantics Khalid/Rinda I/P WG 2009.06.15 OPEN Add support for PCD-01 reporting of PCA-related semantics: settings, status & events. 16 Infusion Therapy Recipe Model Review Cooper I/P WG 2009.09.01 OPEN Provide a review to the Infusion Pump WG regarding the potential application of the draft Infusion Therapy Recipe Model (from the 11073-10301 draft infusion pump specialization standard) for future standardization of infusion pump standardization. - NOTE: This initial discussion should occur before the 2009.09 standards meetings in Atlanta.
17 Review of ICE-PAC Infusion Pump Clinical Work Flow Analysis Cooper ICE-PAC & I/P WGs 2009.07.01 OPEN The IHE PCD ICE-PAC joint working group has completed a significant amount of analysis on PCA clinical workflow, starting with clinical scenarios and working to detailed connectivity & informatics requirements. A general overview of the analysis work should be provided to the infusion pump working group, especially since it would provide strong motivation for future infusion pump activities. The overview will provide: - Review of the analysis process and work products that were developed during the ICE-PAC work
- Specific analysis for infusion pump modalities and infusion therapies.
18 PCA Discussion Engagement Meyer I/P WG 2009.10.05 OPEN Engage additional clinicians & vendors to discuss needs and requirements around PCA therapies. - NOTE: This should be completed after the ICE-PAC analysis overview identified above.
19 HL7 v2 ID Binding Options Rhoads PCD TC 2009.06.15 OPEN Identify the options and IHE conventions for using HL7 v2 to bind orders to patient IDs to device IDs. - (Todd) Post a query to the IHE HL7 Review Task Force.
- Standing orders worked for general DEC reporting; however, they do not work for transactions that are the direct result of an order, such as PIV. The resulting PCD-01 updates need to reflect the triggering order.
- Need to accommodate switches from Channel A to Channel B
- Develop a CP or Brief Profile Proposal to add this to DEC.
- NOTE: See #27 Below for a related action item.
20 Identify HL7 v2 Options for PCA Order Support Berge Rhoads, I/P WG 2009.10.05 OPEN Identify the options for using HL7 v2 to communicate PCA-related order information. For example, investigate the use of - Parent/child orders
- Composite order sets
- ...
- Note: Ruth will post a query to the HL7 O&O group for input.
21 Examples of PCD-01 event/alarm support Cooper/Rhoads ... 2009.07.01 OPEN Provide examples of how PCD-01 may be used to communicate device event and alarm information - for archival purposes. This will be based on content from the PCD TF vol 2, section D.2. 22 Infusion Therapy Info to EHR Discussion Colin FX I/P WG 2009.07.01 OPEN Identify what infusion therapy information is of interest to EHR vendors, especially state transition events. For example, infusion start/stop times. - NOTE: This information should then be updated to the infusion pump model (see above).
23 Pump Semantics Wiki Pages Cooper / Rinda ... 2009.07.01 OPEN Set up wiki pages to enable tracking & discussions for: - Infusion Pump Term Gaps
- Infusion Pump Specialization (model)
- Infusion Pump Therapy "Recipe" Model Discussion
- NOTE: There should be a top-level wiki page for Device Specializations pointing to pages for specific modalities such as Infusion Pumps.
24 ORU vs. RAS Evaluation Berge / Meyer Engelbert, Rhoads, Rinda 2009.10.05 OPEN Evaluate the PRO's & CON's associated with using ORU or RAS messages for communicating medication semantics. - AFTER feedback from PCA Semantics & HL7 support discussion (see above)
- Confer with HL7 ver 2.6 Chapter 4, section 4.6: Pharmacy/Treatment Transaction Flow Diagram
25 Resolve Original vs. Enhanced HL7 v2 Msg ACK Berge / Cooper / Rinda Rhoads, I/P WG 2009.06.15 OPEN The PIV group prefers to use HL7 ver 2 Enhanced Message Acknowledge rules; however, the draft ITI Annex on IHE-wide HL7 profiling guidelines (as well as the IHE PCD TF w/ proposed updates) limits transactions to Original ACK rules only. - (Todd & Ruth) Confer with the HL7 Review Task Force to see whether Enhanced ACK could be used.
- (Ruth) Generate a CP to the PCD TF, if the change is allowed
- (Jeff) Develop an initial list of possible error messages that might be associated with PIV transactions and returned in message ACK responses.
26 CP for DEC OBR-4 Berge / FX ... 2009.06.15 OPEN Develop a CP for DEC vol 2 (B.7) to recommend use of Give Code information (supplied in the PCD-03 RXG-4) in the PCD-01 OBR-4 when used to feed back information resulting from a PIV transaction. 27 Profile Proposal for PoC ID Binding Profile Khalid PCD PC 2009.09.01 OPEN The group reaffirmed an action item that was taken at the PCD F2F @ NIST 2009.05.04 - 08 (Action Item #10) to develop a profile proposal around the point-of-care binding of IDs (transaction(s) + data sets). This would be the PoC compliment to the DEC-PIB combination.
Discussion
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- (Reviewed & approved by PCD Infusion Pump WG 2009.06.04)