LOI Interface
Subject
Facilitator
Location
Attendees
LOI Ballot Reconciliation Call
Date /
10/1/2013
Time
3:00 – 5:00 PM ET
Hans Buitendijk
Scribe
Riki Merrick
Conf. Call/WebEx
Materials
Hans Buitendijk, Freida Hall, Bob Yencha, Craig, Kathy Walsh, Bob D, Mark, Ken
McCaslin, Riki Merrick, Virginia Lu, Les Keepper, Ernest, Eric Haas, Cindy Johns, Gai
Elhanan, Sheryl Taylor, David Burgess, Sara Stewart, John Feikema
Agenda
1. LOI IG Ballot Reconciliation – Hans Buitendijk, Bob Yencha
Key Discussion Points
Update from 9/19 LOI call:
 At HL7 WGM:
 Finished v2.8.1 on OO owned chapters – waiting on chapter 2 changes – O-RE construct was voted
down.
 Any resolution recommendations discussed at WGM is marked in responsible person column with
“LOI ID WG” – please review by next week for block vote to accept these recommendations, or send
note which to pull out.
 Still doing research if we can post to wiki – most likely not, but will send as attachment as reply all
to the email Virginia sent out this morning and also post to HL7 wiki.
 Review the #187 issue today, but not have a vote until we can have NIST, CDC and CMS on.
 Need to focus on negatives and publish by November 2013, then continue on affirmatives, so that
ONC can reference a document in the proposed rule for MU3.
 Reviewing the comments spreadsheet for more input:
 4 Major issues to discuss:
 What should the top level be? – reach out to SMEs to get reasonable top limit, where we can
 How to test the unlimited?
 What do you do when cannot receive less than what was sent?
 MISSED ONE!!!!!
 Green highlighted need review today, while the white are affirmative votes to proposal as is.
 How should we handle the folks not part of S&I? – normally include all who are present
 EHRsystem should only reject, when they cannot handle all the info – do we need to follow up if ALL
(then our approach does not work) or vital fields only – if so, what are the vital fields – ask Ken Beck
 Ask Laura Fochtman if the unlimited cardinality refers to ONLY the vital information, or for all –
seems to be more detail in support of her affirmative vote for the proposal.
 Joe Schneider lists the “vital” information in his eyes – OBR/NTE (or NTE-3), OBX/NTE (or NTE-3) and
OBX segments. - Cannot handle all the OBXes under an OBR, do you have to reject the entire
message, or can you progress the OBR with the OBXes you can handle? Not sure, besides the parent
child / micro susceptibility testing for example linking, if we have the capability to indicate linked
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OBRs – what to do for unrelated OBRs. – Maximum number of corrections or addendums are not
treated differently, besides status, we use snapshot mode; what about add on OBRs…
For Jan Dirk need to follow up what his rejection is related to – partial or complete report and with
or without notification to sender – seems to be more worried about patient safety if you reject, too.
Willa – need clarification on what is imperative.
More support for OBR, OBX and NTE in several lines
Megan gives concrete examples: includes notification to user as well as sender, when there is
modification (truncation etc). What to do about total rejection – do you notify the user.
Follow up with Joel on specifics for unlimited text.
OBR-13 has a recommendation from LOI ballot to use as fasting status, so may be
Missing AOEs – not reject the order message, currently the lab just runs the test ad then does
phone call follow up - need to account for AOE completeness in AOE guidance section – not sure
this is part of cardinality. Do all AOEs have and I don’t know alternative? If yes, then you should
send all AOES every time.
OBR-13 had a lot of work put into it
Riki to review OBX-8 values and give suggestion to upper limit
m..* cannot be for RE field – error in slides
Receiving system sends to sender when they don’t have enough room for the elements - =
application level ACK
Issue with gate keeping systems may do parsing, they may not know if they can handle all the
repeats
Hans comments: allow up regulating on upper limit – as additional profile?
What if the base has the upper limit? – assume base = 1..*, IG states 1..5 – additional profile should
allow 1..8?
Partners should be allowed to go lower than what the constrainable profile requests – comfortable
with sending more, not so much less. – cannot reduce the lower limit!!!
If systems certify to the upper limit in the constrainable profile, then what is the use in reducing the
upper limit.
Increase upper limit only – is that a reasonable idea? Can we check with conformance – need Rob
for feedback here.
Call on Thursday will use the same line as today –
We set up a separate web ex, but using HL7 OO call number for the eDOS call
Call adjourned 5:08PM