LOI Interface
Subject
Facilitator
Location
Attendees
LOI Ballot Reconciliation Call
Date /
9/17/2013
Time
3:00 – 5:00 PM ET
Ken McCaslin
Scribe
Riki Merrick
Conf. Call/WebEx
Materials
Caroline Rosin, Cindy Johns, David Burgess, Eric Haas, John Feikema, Kathy Walsh, Ken
McCaslin, Lester Keepper, Mark Jones, Riki Merrick, Rob Snelick, Bob Dieterle, Sara
Stewart, Sheryl Taylor, Hans Buitendijk, Bob Yencha, Virginia Lu
Agenda
1. LOI IG Ballot Reconciliation – Hans Buitendijk, Bob Yencha
Key Discussion Points
Update from 9/17 LOI call:
 20130917_LOI_Notes
 Attendees: Lester, Ernst, Bob Y, Hans, Riki, Caroline, Cindy, Feike, Kathy, Bob D, Virginia Lu, Sara,
Rob S, Mark, David, Sheryl, Ken, Eric,
 Cardinality issues – see the slides
 Sender and receiver are always be treated the same? – had that discussion, but if we allow senders
to send less than the max number, they would be considered non –conformant, unless we split the
cardinality between these
 Would have to modify the conformance model for this use case – having senders sending less than
the maximum should still work for conformant receivers.
 Unlimited – specification remains unlimited, but testing is to a clinically relevant number
 May want to create a soft max – practical number, but partners can agree above the set limit –
cannot expect unlimited
 If field is 1..* and we test 1..40 – can they agree to less with a partner – yes, but if they use that for
testing, it would fail.
 In cardinality have a bit more leeway to go up or down when we are talking about ..*.
 Important for specific filed, when patient safety is concerned.
 The IG needs to point to the document that defines the testing limits and expected behaviors.
 Behaviors of receiver, when sender sends more than you can handle:
 This will be element dependent – if it has patient safety implications should create hard stop and
error, if not may be able to proceed with the message processing, but still needs to send a warning
 Suggest rename the behavior codes from CE and R to something else, because these may cause
confusions
 LOI behavior may be different from LRI
 OBX-8 in LRI, 0..*  Suggested limits should not be taken as new guidance for de facto limit – NIST testing may go higher
 Example: limit set to 40 – NIST testing to 50, system can take 42 – sending the expected error
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behavior – do I still pass MU certification, because from a conformance testing standpoint your
system is not conformant?
Should we create an actual upper limit for several of these – can review some of these fields – for
example for OBX-8 can analyze the table to find the max limit.
Upper limits need to be known to ATLS at minimum
Slides reviewing the suggested limits
Survey to Anatomical Pathology Informaticists to get their experience of how many
V2 conformance chapter changes:
Need to update definition of cardinality – in v2.8.1 if that is going back to ballot or not
Question on slide 9: some fields have 2 cardinalities – for example OBR-28 a profile can change this
cardinality
m..n should not allow RE, unless m=0 (covers special case of 0,m..n) to cover RE, same for m..*
What are the next steps?
Review and send improvement suggestions to Bob D and Rob S, by due date 10/1/2013, vote on
10/3
Back to spreadsheet:
#110: ORC-3 – add usage note or comment to better explain – filler order number is not usually for
new orders, but may be known for cancel orders accept this text find not persuasive with mod Ken, Mark, no further discussion, against:0, abstain:0, in favor:15
#77: specimen group – create ambulatory profile to include Specimen group – in acute care setting
this may not be needed. Sometimes in inpatient also draws blood and sends to lab
Is currently C(R/O) – if OBR-7 is not valued ‘0000’. – Hans will withdraw
SGH question: SGH needs to be first in the group, SGT needs to be last in the group – Bob to change
#206: EPIC submission; ORC-20 and ORC-26 should have been covered by pre-condition list, so why
should it be sent
OBR-44 is procedure code and OBR-45 Procedure code modifier is – isn’t this related to the DG1
code (don’t they determine medical necessity needs from the DG1 code? In conjunction with the
CPT code of the test) if you have DG1 and ORC-20/ORC-26 and OBR-4 you should be able to have
enough info for this.
HIX PICKS code for a lab test – this is part of the special tables under ICD-9 medicare determines
these tests have special codes – where would that be indicated in the message? Ken thinks that is
using X12 messages – Bob D will look into this
find not persuasive Ken, Bob D, further discussion: add a note – intent is to have this validated as
they go through certification - this will help get this resolved, so the lab can ask the patient to sign
the ABN, so the lab can perform the tests , against:0, abstain:0, in favor:15 Ken to write up this note
#207: only deal with oral request when they are add-ons to existing orders – ORC-15 is effective
time of oral order should be noted in EMR; motion to find not persuasive Ken, Bob D, no further
discussion, , against:0, abstain:1, in favor:14
#115: IF TQ1-8 is used to you are trying to convey that you shouldn’t collect the specimen later than
– then you need to use it RE and TS_5 – not persuasive with mod – add comment: latests date and
time by which the specimen should be collected, Bob D, Eric, no further discussion, , against:0,
abstain:0, in favor:15
#116: ORC-3 shall not be the same in two ORCs within the same order group, as there is only one
ORC – was the intent then to have within the same message? LOI-41 – does that cover the previous
results – same message, excluding the prior results group(s), Riki, defer till Thursday
Take out LOI-42 from the PRU component?
Call adjourned 5:07 PM EDT