PCD PIV 2009-05-19 F2F

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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)
Google Map for Location


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

Meeting Materials Loaded on the IHE PCD FTP site...

Discussion Notes

Participants

NOTE: Please check for proper spelling and that all participants were included

Chair/Host: Jeff Rinda (Hospira) & Khalid Zubaidi (Cardinal)
Ruth Berge (GE), 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), 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 ... 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.
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 ??? PCD PC 2009.06.01 OPEN There is a need for better coupling of work flow 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...)). This should be added to the IHE PCD Planning Committee discussion agenda.
7 CP for ORC-2 Berge / Meyer ... 2009.06.05 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 PCD TC 2009.06.15 OPEN A single infusor can have multiple orders (one per OBR) per an infusion pump. Need to choose:
  • 1. Multiple OBRs per PCD-01 update
  • 2. Multiple messages per infusion order
  • 3. 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 RXG-18 Rinda ... 2009.06.05 OPEN

Draft a Change Proposal for PIV that RXG-18 is 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 2009.06.05 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 Ensure that the identified syringe pump semantics are added to the Infusion Pump model + Rosetta.
13 CP for RXR-3 Meyer I/P WG 2009.06.05 OPEN Update PIV specification for RXR-3 to:
  • Support "RE" instead of "R"
  • Support "syringe"
14 I/P CP Wiki Rinda CP Owners 2009.06.05 OPEN Create a wiki page to capture and discuss PIV-related Change Proposals.
15 PCA Semantics ??? 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 2009.07.01 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.
Note: Please respond to the Doodle poll to schedule this review session during the last week of 2009.06
18 PCA Discussion Engagement Meyer ??? 2009.07.31 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 2009.06.05 OPEN Identify the options and IHE conventions for using HL7 v2 to bind orders to patient IDs to device IDs.
  • Should post a query to the IHE HL7 v2 Coordination group.
  • Need to accommodate switches from Channel A to Channel B
  • Develop a CP or Brief Profile Proposal to add this to DEC.
20 Identify HL7 v2 Options for PCA Data Support Berge Rhoads, I/P WG 2009.07.15 OPEN Identify the options for using HL7 v2 to communicate PCA-related information. For example,
  • Use parent/child orders
  • Use composite order set
  • ...
Note: Ruth will post a query to the HL7 O&O group for input.
21 ??? Meyer/Rinda PCD TC 2009.07.31 OPEN Develop a CP or Brief Profile Proposal for <need to clarify with other participants...>
22 Examples of PCD-01 event/alarm support Cooper/Rhoads ... 2009.06.05 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.
23 Infusion Therapy Info to EHR Discussion ??? 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).
24 Pump Semantics Wiki Pages Cooper / Rinda ... 2009.06.15 OPEN Set up wiki pages to enable tracking & discussions for:
  • Infusion Pump Term Gaps
  • Infusion Pump Specialization (model)
  • Infusion Pump Therapy "Recipe" Model Discussion
25 ORU vs. RAS Evaluation Berge / Meyer Engelbert, Rhoads, Rinda 2009.0.15 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
26 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.
QUESTION: SHOULD THE ABOVE BE A SEPARATE ACTION ITEM???
27 CP for DEC OBR-4 Berge / FX ... 2009.06.15 OPEN Develop a CP for DEC vol 2 (B.7) to recommend use of the Drug ID in OBR-4 when used to feed back information resulting from a PIV transaction.
x abc THC I/P WG 2009.06.05 OPEN ...


Discussion

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