PaLM F2F Minutes 2018-Nov-12

Attendees

	Nov 12 AM	Nov 12 PM	Nov 13 AM	Nov 13 PM	Nov 14 AM
Francois Macary	x	x	x	x	x
Riki Merrick	x	x	x	x	x
Raj Dash	x	x	x	x	x
Kenichi Takahashi	x	x	x	x	x
Naomi Ishii	x	x
Filip Migom	x	x	x	x	x
Jim Harrison	x	x	x	x	x
Mary Kennedy	x	x	x	x	x
Gunter Haroke			x	x
Alesandro Sulis	x	x	x	x	x
Francesca Frexia	x	x	x	x	x
Andreas Vendel			x
Dan Rutz		x	x
Ed Heierman		x
Francesca Vanzo	x	x	x	x	x
Megumi Kondo	x	x	x	x	x
Mario Villace	x	x	x	x	x
Ed Heierman		x
John Hobson			x	x	x
Nick Haarselhorst			x	x
Mikael Wintell			x	x

November 12, 2018

Introductions were given and the agenda and goals for the meeting was reviewed by Francois.

PaLM Deployed Around the World

Japan update slides available here

Kenichi reviewed the IHE activities in Japan. The October 2018 Connectathon in Tokyo had 250-300 attendees from 10 companies with 45 instances of established connections. The 2019 Connectathon will be October 7-11 in Yokohama, Japan. Several dates were presented for the 2019 IHE PaLM F2F meeting in Tokyo. The most likely dates will be May 27-29. Other dates include: June 3-5 (no Riki); June 19-21; June 24-26. A final decision will be made in the next month of

Europe update

(https://www.ihe-europe.net/news/events)

The 2019 Connectathon will be April 8-12 in Rennes, France. Roche might bring their middleware; MIPS is planning to test TMA (bloodbank) (hopefully EPIC will be able to join MIPS for TMA);

Implementations: France big hospitals are implementing LTW and LCSD profiles. In Sardinia, Arsenal is working to get labs of the entire Veneto region to adopt LOINC; they have software that offers LOINC mapping; LOINC is used for results. Orders use national codes.

North America update

(https://www.iheusa.org/ihe-na-Connectathon-2019)

The 2019 NA Connectathon will be held January 21-25 in Cleveland, Ohio.

IHE PaLM Board Report Board Report Available Here

Riki reviewed the draft PaLM Board report. The following issues were discussed

• Technical Committee Co-Chair in Japan – Kenichi may be the co-chair pending a decision by IHE Japan and JAHIS
• Mary will have Sabrina update the 2018 meeting roster
• Inpeco – LBL deployment – Alessandro to find out in the next few days
• Japan deployment - Megumi provides during the meeting, the webpage links also for IHE Japan and JAHIS
• Belgium- KHMER based on XD-Lab – content is XD-Lab with an XML wrapper. So KHMER is replacing the IHE XDS wrapper, but XD-LAB is used plainly within this KHMER envelope. – in trial proof of concept (end of 2019 should have final specification including LOINCs) – this will be removed from the draft report for now
• The Netherlands - LAB-1 and LAB-3 for LTW operational with EPIC and plan implementation of TMA next quarter University of GRONINGEN (UMCG). Filip is the contact.
• IHE presentation – introduction to IHE PaLM activity and technical framework at JACLaS October 11-13, 2018 (Kobe, Japan)
• Presentation of IHE basics and DICOM Digital Pathology Visions meeting November 5 – 6, 2018 (San Diego, CA)

- There was support of a joint IHE and DICOM Connectathon – now looking for date for the Connectathon in 2019: first IHE option April 8 – 12, 2019 in France; this may be too early, a better plan is for North America Jan 21-25, 2020. An alternative is to host it at the next Digital Pathology Visions meeting in October 6-8, 2019 in Orlando, FL. DPA would support that.

- PaLM is invited to the European Pathology Congress for a joint meeting with DICOM WG 26 on April 11 – 13, 2019 Warwick, GB

- Will LAW and LIVD be CLIA recommendation? There was a CLIAC meeting was last week; Mary to find out if it was on the agenda.

- OO has a project to provide mapping v2 to FHIR elements; possibly after that and when FHIR has workflow worked out we could target work on LOI and LRI

- Remove the harmonization bullet but add a bullet about discussion to create new LCSD profile based on FHIR catalog resources

- Need to still get feedback on the LIVD and LAW piece from Ed

- Include future plans for TMA

• There was a comment ballot in May 2018, have to publish as Trial Implementation – need to check with Dan to get that done, then we have the technical team to build the profile in Gazelle
• Also has possibility of implementation at university hospital in Belgium (Leuven + Antwerpen)
• In December Filip to meet with Epic Netherlands about implementing TMA (December 19th : MIPS offices in Ghent Belgium)

Specimen Event Tracking (SET) Vol 2 Review (SET) Powerpoint Available Here

Alessandro reviewed SET to date:

• Will work in parallel on HL7 CR and Vol 2 editing using z messages until Hl7 approves the new message structures
• Looking at the message structure document

- Z01

• More than 1 PRT segment following the EVN?
  • Idea there is to use it when a participation is valid for ALL the following segments
  • We may have to remove PRT after EVN and then create a specimen group that has PRT and OBX
  • And a group for container prep an have PRT after container, too
  • For each specimen, would there be more than one collector?
    • PRT can track person, organization, location and device, so if there was interest in tracking the person and the device used for the collection = assume ONLY 1 PRT, since matrix ONLY lists the person at this point
      • Example US guided biopsy (the needle, the laparoscope and the US used?) – do we need to expand the use case described?
• For all PRT segments following the EVN (if EVN = act, then following v3 logic it could be there, but how to then declare when more than one specimen is collected or more than one device was involved in preparing the container) – since we are creating messages for tracking an event
• Currently we lean towards having PRT following the EVN, since 1 event is being described
• => create different options for the HL7 CR
• Need to also expand the HL70912 codes to support this
• Adding in the ORC and OBR – just to have the order numbers (ORC-2/OBR-2, ORC-3/OBR-3, ORC-4) and the test ordered (OBR-4) – make the order group optional
• No need for the TQ1 segment, unless we need the priority for the order
• For container preparation – do we ALWAYS know the specimen already?
  • Yes for SET
• Specimen collection missed event:
  • Where to place the missed reason – OBX/SPM, or add NTE somewhere – NTE-9 supports coded, NTE-4 would be coded to express reason
  • As alternative could make different message trigger (in MSG.2) and use the EVN-4 and not have NTE
• SAC-27 is container material – as well as any additives – there is a CR at OO that may rename that field
• EVN-4 is the event reason code – we are using that to describe the event type, since EVN-1 is withdrawn – we may have to create trigger events for each, so that the MSH-9.2 would have a different trigger event

- Z02

• If physician updates a specimen to move the patient from one location to a different one – may miss the shipment,
• Missing the shipment status? Have
• What does the shipment ID represent?
  • Each message is ONLY about 1 shipment
  • Use the PRT segment to declare the from and to location following the EVN or SHP?
  • MUST have at least 1 PRT to cover at least the from location (PRT-9), but could have more like person shipping, or organization shipping as well as intended recipient
  • If the message is about just 1 shipment, then no { for the shipment group)
  • Need to define new codes in HL70912 – depending on how we define the codes, may be able to document shipping location and organization and person in one PRT? Also, could add code for intended recipient of specimen or something like that.

IHE LAW and CLSI AUTO16 update

Ed updated the group on CLSI’s incorporation of LAW into AUTO16 as well as LIVD and FDA:

• For inclusion into the IHE PaLM Board report:
  • AUTO16 – has been sent out for public review – due by 12/10
  • After that editing and approval assume Q1 of 2019
  • LIVD on FHIR is getting close to getting stable definition, will have Connectathon track Jan 2019 and ballot May 2019
  • FDA is reviewing a grant proposal to have funding for proof of concepts to implement both LIVD (FHIR) and LAW (vendors, LIS and middleware participants)
  • CLSI automation and interoperability expert panel is working with FDA to create an interoperability and guidance document focusing on LAW, LIVD and potentially some of the other IHE PaLM profiles (LTW) – maybe eDOS (FHIR) potentially LOI/LRI, too = this plays into potential updates to LAB-1 and LAB-3 due to digital pathology needs.
  • Spell out FDA, MDIC the first time in the report

Transfusion Medicine A (TMA) update

Filip and Dan presented an update on TMA:

• TMA plans
  • Have completed public comment
  • Needed to add sample messages before publishing Trial for Implementation
  • Want to have Connectathon soon, but would need it for Gazelle team as soon as possible
  • Dan will try to finish any edits by end of this week
• 2 additional use cases for new profiles:
  • Ordering of blood products (create a new profile – how to adjust LAB-1 to accommodate the existing message structure in the base (OMB)
    • University of Leuven has joint venture to deliver software services for 26 hospital services in Belgium
    • MIPS working on that with EPIC (12/19 meeting with Dutch colleagues including standardizing the dispense information)
  • Dispense = once order is placed in lab – follow up of information in the lab status of blood bag after crossmatch, but before TMA is triggered, no underlying standard exits

2019 Call for Proposals

We will open the call for proposals on November 16 and close it on January 3, 2019. Decisions regarding new proposals will be discussed on the January 9th 2019 conference call.

Laboratory Clinical Communication (LCC) update

Riki and Jim gave an update on the LCC:

• The document was reviewed; Riki will update the document per the notes and will share it with the group
• We will review again on Wednesday; the plan is to send to Mary Jungers by end of this meeting; expect it will be published within a week or so (could be longer due to holidays)
• Jim and Mary will write an announcement to send to CAP committees asking for their input
• Have open for comment till Feb 8th, so we can review any on call Feb 13th

The meeting adjourned for the day at 5:00PM local time.

November 13, 2018

Francois reviewed the agenda for the day. Introductions of new attendees were made.

Digital Pathology Update (IHE white paper link and PPT from Raj)

Raj lead the discussion for the day on the work of the digital pathology white paper (https://wiki.ihe.net/index.php/APW-EDM_White_Paper)

• Image Acquisition profile was the focus of the day with the following discussion/decisions:
  • The Actor transaction diagram from Francois was displayed. It is ambiguous how the roles for image archive and image manager are connected – they are grouped in one system.
  • At the DICOM WG26 Connectathon and F2F meeting in San Diego there was a summary of the 2 year progress. DICOM now wants to expand the workflow and is looking for reasonable steps to implement rather than trying to build it all. There is a WG with biweekly meetings to move these profiles forward in one year. At the joint IHE PaLM/DICOM26 meeting in Helsinki, it was decided to focus on image acquisition and to design a joint Connectathon around that.
  • Agree tp split the image manager and image archive into 2 separate actors for AP (example: Duke will use a radiology archive, but have different image manager for AP); the image archive can hold DICOM and non-DICOM images
  • Should we include transactions between those 2 actors? It is the same as the image archive manager in slide #2 in the ppt; decided to keep those boxes together – Raj was thinking of the acquisition manager
  • Image display is missing from the transaction diagram on slide 3 – because it was not covered in top priority
  • Rename “Procedure request” to “work order request” (to be in-line with PaLM TF vocabulary) – this comes from the AP Framework:
  • Add image from AP TF – Figure 1.13
  • Procedure request can be split into multiple workflow steps, so keep procedure request
  • Do we keep image display in scope – will be helpful for Connectathon success as well as imperative for the work, so it was decided to keep it in scope
  • Need to add 1 more actor – with 2 transactions QIDO-RS (Query Images for DICOM Object) or RAD-14? = WADO-RS (Web Access to DICOM Object = RAD-55) RS = restful – name of these transactions query for digital asset / retrieve digital asset
  • The Image manager is better split per Mikael, so need transactions between them
  • Acquisition modality is also a part of the image manager – this needs to be reconciled.
  • Image manager to image archive C-MOVE, C-FIND, C-GET, C-STORE (is part of radiology workflows)
  • In future supplements we can describe interactions between the image manager and the image archive – for this profile we define those actors as grouped; even for the use case of exchanging images between 2 image archives, both those systems have both actors