Laboratory Orders Interface
Subject
eDOS Initiative
Facilitator
Location
Attendees
Dave Shevlin
Conf. Call/WebEx
See “Meeting Attendees” on Wiki
Date /
Time
Scribe
Materials
7/31/2012
2:00 – 3:00 PM ET
Saunya Williams
Agenda
1. Announcements
2. eDOS Use Case Review
3. Next Steps
Key Discussion Points
1. Announcement

None for today
2. eDOS Use Case Review

Last week, we reviewed Scenario 1 and Scenario 2 and updated the activity diagram and base flow for
Scenario 1
Figure 3: Scenario 1 Activity Diagram
o Starts with either Step 1A or Step 1B
10.0 User Story
 Reviewed the second paragraph beginning with “Upon the initial acceptance of the laboratory test
compendium…”
 Per Freida H., suggested adding a footnote
 Per Glen M., suggested “As scheduled or as requested, a Compendium Producer electronically sends…”
o Per Scott R., I think this revision is much better
 Per Dave S., I don’t think that subset was intended to describe incremental updates
 Per Mike F., does a Compendium Consumer have software to parse information within the
compendium? Or do I have to negotiate with the laboratory regarding the specific information that I
want?
o The laboratory makes the entire compendium or a subset available and the consumer has the
ability to do whatever
 Per Freida H., I think we are just trying to ensure an electronic format as opposed to the current manual
process
 Per Bob Y., is the eDOS agnostic or required to support subsetting?
o Per Ken M., I think that the guide suggests that you have the capability if you want to provide it,
but the ultimate responsibility of extraction is up to the individual lab
 Per Scott R., a consumer may only want to display a portion of the compendium
 Per Bob Y., I don’t think we are locking the consumer into working with a particular lab
 Per Mike F., I don’t see LabCorp and Quest moving rapidly toward standardization
2/18/2016
1









Per Bob D., the patient’s insurance often chooses the laboratory, not the lowest price or the physician
Per Mike F., suggested that the standard should afford flexibility to allow the physician to choose the
laboratory
Per Freida H., I think that the labs are moving toward standardization in an effort to support MU
Per Bob Y., the laboratories have their local codes, and we are moving toward the direction of mapping
to standard codes (e.g., LOINC). I agree that the market will probably require a more standardized
approach
Per Mike F., I am hoping that the market will move toward more standardization and improve efficiency
Per Freida H., suggested to add as a “Parking Lot “item
Per Mike F., I would like to see it added as a “Parking Lot” item or “Out of Scope” as a reminder
Per Freida H., I was also thinking that the Pilots may have some feedback on the use of subsets
Action Item: Add to “Parking Lot” or include as an “Appendix”
3.2 In Scope and 3.3 Out of Scope
 Per Freida H., suggested adding “Automated subset creation…” to 3.3 Out of Scope and suggested
adding “Full or subset…” to 3.2 In Scope
 Final Decision: Added “Full or pre-defined subset of…” to 3.2 In Scope
 Per Glen M., is this only applicable to the US Realm, ambulatory-care setting like with LRI/LOI?
 Per Freida H., I think that the DOS guide was agnostic to the type of care setting. I don’t think that ACLA
was trying to constrain the document when it was created
 Per Riki M., we can revisit the “US Realm” topic within 3.2 In Scope in the future
 Final Decision: Added “US Realm” to 3.2 In Scope
12.1 Information Interchange Requirements
 Per Scott R., suggested adding “or pre-defined subsets” to the first row in Table 5
 Per Harry S., suggested adding the “EHR System” for “Request for Full Directory of…”
 Per Dave S., added “EHR System” for “Request for Incremental Updates…” to complement the first row
 Per Riki M. and Glen M., suggested adding “LIS” for “Process Request for Electronic…” to Table 6
 Per Dave S., added “EHR System” to “Create Request for Electronic…”
 Per Glen M., laboratories can build their DOS on the fly?
o Per Freida H., I think we’re inserting the notion of making an electronic request
 Per Dave S., I see Glen M.’s point because we had the “request” in in a previous version
 Per Bob D., I think it will depend on the technology of the laboratory. Some may build on the fly
 Per Dave S., I don’t think that the order sequence makes a difference so we will leave the table as it is
 Per Megan S., do we want to have the ability for the lab to automatically provide the compendium?
o Per Freida H., we have the 1A and 1B
o Per Dave S., I think that “Full Directory of Services or subset “ addresses that question
 Per Glen M., what about the explicit acknowledgement after the EHR receives the Compendium? We
were explicit in LRI and LOI
 In regard to Orders, the need is clear, but the DOS doesn’t have the same need for acknowledgement
 Per Freida H., we talked about this and reviewed LRI, but I don’t think that LRI had it explicitly. We do
have an escalation process for LOI
 Per Bob Y., we didn’t diagram out the acknowledgement LRI and added as a “Parking Lot” item. We
agreed that an escalation process needs to be defined. We are looking to learn from the pilots. Errors
can be Delivery, Structure, or Content
2/18/2016
2






Per Glen M., DOS may not need the ACK as with LRI and LOI, but I wanted to ask
Per Bob D., we define the ACK in 3.2 of the LRI IG where it’s appropriate for the transport mechanism. I
think we should do the same thing for the Compendium, but we don’t know yet
Per Bob Y., we haven’t gotten into that level of detail with LOI yet
Per Freida H., we are just using the accept acknowledgement
Per Bob D., there are 2 versions: MLLP (protocol level) and the HL7 ACK (message level)
Per Patrick L., with the HL7 version ACK, the ACK can do accept-level processing and can do applicationlevel processing
Dataset Requirements
 Per Dave S., we need to discuss changing the references to the” X” (i.e., not supported) elements to
optional
 Per Freida H., in LRI, that looked at the elements as “not supported” in ELINCS and determined if they
wanted to make them optional. I don’t know if LOI took the same approach
 Per Riki M., LOI only uses “X” if it’s only there for backwards compatibility or has been deprecated
 Per Freida H., what do we want to do for eDOS?
o Per Bob D., I think this depends on the assumptions of the implementation of the guide
o Per Freida H., I think that we should take the same approach and be consistent
o Per Patrick L., we also don’t want to support the “W”, but “B” elements are on their way out
o Per Bob Y., we will deal with this during the alignment process
 Per Dave S., I will repackage this spreadsheet in a more user-friendly format and post to the wiki for
your review
3. Next Steps


Action Item: Dave S. will send follow-up email with summary and instructions
Homework: Conduct an End-to-End Review of the entire Use Case and finalize the In-Scope/Out of
Scope items prior to next week’s meeting
Action Items
Subject
Item
Owner
eDOS Use Case –
Compendium Subset
Add to “Parking Lot” or
include as an “Appendix” to
be addressed in the future
Repackage the spreadsheet
in a more user-friendly
format
Send follow-up email with
summary and instructions
to the community
eDOS Use Case –
Dataset Requirements
eDOS Use Case
2/18/2016
Status
Dave Shevlin
Due Date/
Timeline
8/1/12
Dave Shevlin
8/2/12
In
Progress
Dave Shevlin
8/2/12
In
Progress
In
Progress
3
Homework
2/18/2016
End-to-End Review of the
entire Use Case and finalize
the In-Scope/Out of Scope
items prior to next week’s
meeting
Community
8/7/12
In
Progress
4