2015-06-02 – Continue review eDOS document

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S&I Framework: Laboratory Orders Interface (LOI) – eDOS WG
Subject
Facilitator
Location
Attendees
Regrets
LOI eDOS Workgroup
Date /
06/02/2015
Time
2-3 pm Eastern
Freida Hall, Mark Jones
Scribe
Freida Hall
Conf. Call/WebEx
Materials
Freida Hall, Mark Jones, Ken McCaslin, Bob Yencha, Kathy Walsh
Agenda
1.
2.
3.
4.
5.
Agenda Review
Announcements – S&I calendar (Bob)
Continue eDOS reconciliation (2015Jan ballot)
AOE update; ballot #110
Follow up from discussion with Orchard Software representatives (July 22):
Latest proposal OM4 segment additions at: http://wiki.hl7.org/index.php?title=OO_CR168-818-OM4Addition
Note: 2014-12-16 version of update to Additives Spreadsheet from Kathy Walsh in notes below; file name:
"Aditives20141203.xlsx".
6. Standing agenda items: Review eDOS DSTU tracker:
http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=105
7. Next Call – June 9
Page 1 of 12
Key Discussion Points – Quorum is Co-Chair plus 4 (with no preponderance of influence)
1. Agenda Review: Approved, no new agenda items
2. Announcements: Bob discussed pending changes to the S&I calendar; you will be able to subscribe to all lab work groups or individual work groups.
3. Continue eDOS reconciliation (2015Jan ballot) - Deferred, pending other action, see notes below re: AOE ballot reconciliation item #110.
V2_IG_LTCF_R2_D2
_2015JAN_2015-05-19.xlsx
**File above from May 19, 2015 call (2015-06-02 this is most current version)
(Reminder) Should we post the spreadsheet in the notes or post to the wiki – the latter may make it easier to find, since sometimes you don’t remember the
date to look at specifically – will post both ways as a starting point.
4. AOE update; ballot #110
2015-05-14 (Partial) Motion to remove Data Type when AOE is to be sent in a specific HL7 field, e.g. PID-10 by Kathy Walsh, second by Mark Jones. Motion
carried 6-Affirmative; 0-Abstain; 0-Against.
Freida will apply AOE changes to the eDOS IG, then WG will review; also make note of changes from published eDOS IG the WG might want to consider.
2015-05-19 - Review eDOS document changes applied
Looked at edits applied to Appendix A (AOEs) and resulting questions:
AOE usage notes – should we add the SCT code for suggested values? Example collection method – base standard says either HL70488 or SCT, except Vet
med – they can use what they prefer per industry – HL7 tables can be extended – if you extend using a standard code, identify the standard code system,
what should you do for a local code? Riki to research the list serve question outcome.
Similar question for SPM-8, but there we have a lot of concepts in both HL70070 as well as SNOMED CT.
Seems we are using the same LOINC for different AOEs – if folks are using these for AOEs would be hard for EHR-S to know what to display. Will pick up here
next call.
2015-06-02 – Continue review eDOS document changes applied
AOE Lists for eDOS
use_PostLabMCoP call 20150602_edits.docx
**File above from Freida documenting edits applied
5. Follow up from discussion with Orchard Software representatives (July 22):
Page 2 of 12
From July 22 minutes: Specimen requirements and container descriptions – should we add coded fields for these to
v2.8.2 - or V2.9? Do we have vocabulary we can use for that? LabMCoP will take a look at existing vocab this week
(Thursday); if you have any suggestion/info on this issue, send to Mark, Riki, Cindy, Freida, and Kathy. (Cindy will be out
for 2 weeks starting next week).
Follow up email from Riki Merrick:
Re eDOS call
notes.msg
Container volume is in OM4-4
Additive in HL70371 – HL7 defined table (already in OM4-7)
Special Handling Code HL70376 - User defined table (already in OM4-15)
LabMCoP is doing homework on possible vocab addition to these existing tables
For fields that are TX may need to have a guidance note to clarify, what the source of truth is if the coded related field has differing information from what is
written in the text – consider DSTU comment for eDOS to be that way (Mark will discuss with his team). Can also consider some guiding text on what to include
in the text field.
Also Mark may create a v2.9 Change Request for any more coded elements to added – tube top color, container material – in addition red top glass tube code
and possibly include a new field CQ data type for time sensitive specimen.
2014-08-12 info from Kathy Walsh:
Email from Kathy Walsh:
Finding a reasonable list has proved to be more difficult than I thought it would be. In our compendium we send text
and when I deleted the duplicates I still had over 700 containers because of extra information, container options, and
formatting differences. So what I am sending is not an all-inclusive list but is a list of basic containers for our regular test
and does not include transport information.
Thanks,
Kathy
Tube Descriptions
Gel Barrier Tube
Serum Transfer Tube
Lavender-Top (EDTA) Tube
Slide
Urine Bottle
Gray-Top (Sodium Fluoride) Tube
Blue-Top (Sodium Citrate) Tube
Page 3 of 12
Tube Descriptions
Plasma Transfer Tube
Red-Top Tube
Swab (non-micro)
24 Hour Urine Container
Body Fluid
Stool
CSF (Cerebrospinal Fluid)
Green-Top (Heparin) Tube
Amniotic Fluid
Royal Blue-Top (EDTA) Tube
PKU Card or Filter Paper
Yellow-Top (ACD) Tube
Plasma Transfer Tube with Trasylol
QuantiFERON
Tissue
Whole Blood
Urine Monovette
Gastric Fluid
Sputum
NMR LipoTube (Black/Yellow)
Urine Transport Tube
ColoSure
Semen
Cytec Vial
Paraffin Block
Polymedco iFOBT Bottle
Other (Miscellaneous)
Breath Bag
Holter Monitor Kit
Calculi
Tan Top Lead-Free Tube
Holter Monitor
Percloric Acid (Gray-Top Tube)
Urine with HCL Preservative
Urine with Boric Acid Preservative
Urine with Acetic Acid Preservative
Page 4 of 12
Tube Descriptions
Urine with Sodium Carbonate Preservative
Vacutainer with No Additive
Affirm Transport System
Quantisal
ORASURE
QuickVue iFOB Tube
BD SST Tube
VIAL TriPath Collection Vial
Aptima (Gen-probe) Endocx/ureth swab
Aptima Org
Digene HPV Transport
Aptima (Gen-probe) Urine
Progensa Urine Transport Tube
Kidney Stone Container
PPT (White)
Urinalysis Transport(Red/Yellow)
Previously Prepared Cyto Slide
Urine Culture Transport
Gen-Probe (PACE) endocx/ureth swab
Bacterial Cult Trans Swab w/Media
Bacteral Cult Trans Swab Dry
Sterile Cup
Para Pak - Gray
Para Pak - Pink
Para Pak - Pink & Gray
Para Pak - Orange
Para Pak - White
Blood Culture Bottles
Jembec
Anaerobic Culture Transport
Bordetella Culture Transport
Viral Transport System
MicroTrak
Organism Isolate
Gray-Top Vacutainer Urin Culture
Attest Vial
Page 5 of 12
Tube Descriptions
Trichomonas Transport
Fecal Occult Blood Card
Pediatric Blood Culture Bottle
Naso-pharyngeal Swab
Millipore Filter
Miscellane Other Micro Transport
Plated Media
Probe Tec
Uniprobe
Plasma from Light Blue Top Tube
Plasma from Lavender Top Tube
Plasma from Green Top Tube
Plasma from Royal Blue Top Tube
Plasma from Yellow Top Tube
Plasma from Gray Top Tube
Plasma from PPT(TM) Tube
Urine 24hr No Preservative
Urine 24hr 6N HCl
8/12/2014: Could add these as common textual descriptions and then request a new field for coded data in future.
Possibly also request an additional field that you can list the time requirement to ship the specimen by (in minutes / hours / days etc.) to identify specimen that
cannot be shipped as part of a batch.
8/19/2014: (2014-10-28 Note: This spreadsheet is now outdated, see later version below.)
OM4_related_Vocab
ularyKAW20140818v2.xlsx
Discussion on this call:
Need to review the container type list against the additive table to ensure all additives are covered – should include comments with those to indicate when to
use some of these, where currently done in the compendium.
For some tests we seem to have to have two different tube types – was this at the analyte level - Kathy will take a look
Cindy suggests: Kryofibrinogen testing compares reaction in two different tubes in plasma and serum tube after refrigeration – create a code that combines two
tube types into a single concept
If we want to code container types may need to request that new field – do we want to deprecate the TX field in favor of the new coded field or allow both?
Would need to do that before the Sept WGM.
Add new field for coded container types using CWE – and deprecate the TX field? Mark to draft for next week
Page 6 of 12
In the container field currently also have notes about where to order containers – how to handle that?
9/2/2014: Reviewing the OO proposal (see above under agenda): Add new field to OM4 to codify container type = SPM-27 – should this field be repeating. SPM27 does NOT repeat. Add new code to HL70376 for critical time sensitive – deliver to lab within timeframe specified in new field.
Or add new field using Y and N as allowed answers to indicate, if time-critical. Or have just one new field called time critical delivery time – if not populated, then
not time critical?
We need to figure out how to message, when 2 containers are required for one test – if you send 2 OM4 segments and if the OM4-17 is not filled in then would
that mean and? Not yet. In the notes we have Example for Preferred specimen where OM4-17 is listed as ‘P’. May need more text for this. Would we need an
indicator in the OM4 segment that the specimen is required. If both are marked P would that be the indicator for AND? The rule in OM4-16 indicating only one P
for each specimen type does not work for Cindy’s example, where she needs blood with two different additives (Yellow top and lavender and both have to be
sent).
Preference is for just having the specimen delivery time field. Let’s not add the time critical code to specimen handling.
Do not deprecate the container description – leave for notes about the container, or deprecate and add a new field for all the other information folks currently
put into that field.
Currently have no specific code system to draw from for container types – would need to look, if there are appropriate SNOMED codes or there vocab out there
9/9/2014: Mark sent updated proposal (see above) have OM4-19 as CWE for container type; OM4-20 Specimen delivery time as CQ (if populated, the delivery is
critical and will be rejected, if not transported in that timeframe). What about OM4-3 – leave or deprecate? Kathy prefers to leave – do we want to have the list
of containers as examples?
Folks are using TX fields for all sorts of additional information – so may be add a sentence to point folks to use the coded field to identify the type specifically. To
identify container types as coded values use OM4-19 (Container Type).
Kathy looked at the specimen condition or handling table in the ballot value set and saw more codes than she thought were there.
Make table for OM4-19 user defined and propose codes for folks to review in v2.8.2 ballot.
Ken drops off.
Provenance discussion - How do we know who makes changes to the table values? It would be in the OO minutes and ballot reconciliation to be found – but in
practice for user defined tables you sit down with the partners and define what will be used.
Need to also include the OM4 segment table etc.
Move all the detail changes to Section 4
Add impact: Implementers will need information from OM4-3 text format to OM4-19 coded format.
Motion to accept the proposal with proposed changes Riki Merrick, Mark Jones, no further discussion, against: 0, abstain: 0, in favor: 7
Frieda and Mark will upload to the OO wiki (seems to have issues with uploading the file)
2014-09-23 HL7 WGM discussion – OO requested to add segment table to proposal (CR166-818); this raised question of element number and 'reuse' of SPM-27
element in master file. However SPM version uses Table 9999; proposal CR166-818 proposes User Defined table. Also using copyright names in table was
questioned; may need to add appropriate copyright/trademark. Publishing recommends using same element # if possible, but still have table issue (9999 vs.
new User Defined Table.)
Per HL7 Terminology Authority (HTA) should use 9999 in the underlying standard and then publish the constrained table in eDOS – will have to create a code
system for these concepts – also need to review concepts for the actual container types covered rather than referencing the specimen types contained – Kathy
to do a little more work on this one (will add a definition for the container types and possibly where they are used)
Page 7 of 12
How to deal with trademark symbol in table / messaging = Action: Freida to check with HQ on how that is handled
Motion to approve using SPM-27 item# and table number in OM4-19 Mark Jones, Riki Merrick, no further discussion, against: 0, abstain: 1, in favor: 7
2014-09-30 Reviewed HQ response. Motion to remove from the table items that are trademarked, and add note that this is not exhaustive list and trademarked
items are excluded by Mark Jones, second Les Keepper. Against-0; Abstain-0; Affirmative-8. Kathy will continue work on the table. Action: Review table next
call; Freida to post proposal update from eDOS call to OO wiki.
Kathy had comments/questions about containers from her research:
 Top colors don't necessarily control additives (OM4-7 Additive)
 Do we care if containers are glass or plastic? No
 Do we care about stoppers vs. caps? Yes – may impact automated functions.
2014-10-14: Added 2 tabs – basic list of containers – too basic to be useful, second tab – deleted additives and other words – want to check that list of additives
against the official table for additives (Kathy to do) – Bob will post to wiki, will discuss on the next call.
Les question: A big push that lab results be available to the patient – there has to be some kind of demarcation that some information must stay with the
laboratorian. Final rule for CLIA amendment was released in 2013 that allows patients to get copies of their lab results – at federal level – labs are trying to make
that information useful to the patient. There has to be the relationship between the doctor to help translate the lab results to make them meaningful to most
patients. People are trying to structure the information useful in many different ways – having the detail at least gives a patient the option to take this to the
2014-10-28: The glass vs plastic may be important for some tests, but in general not needed. Kathy is now reviewing additives to be sure HL70371 has all of them
that are needed.
OM4_related_Vocab
ulary20141010.xlsx
Please review for next week's call (11/4).
2014-11-04: Base container list is too basic – need to use at least the abridged container type list – which we had to remove all the trademarked terms,
reviewing this now:
Additives tab = HL70371 Kathy is still working on this one
HL70396 – not sure what chilled refers to, so don’t add – but add the other two missing terms – do we need to
Chilled is not referenced in Quest, LabCorp, PAML, Mayo – so let’s not have it.
Motion to approve table as listed in the spreadsheet Mark Jones, Riki Merrick, no further discussion, against:0, abstain:0, in favor: 8
Container type - do we need metal free? Have that as specimen handling, so don’t add specifically
What about differentiation between glass and plastic?
The base standard for the element we are reusing points to an outside code system, so we won’t get an HL7 table number – use an external code system if we
want to get a new HL7 table number assigned for user defined table and deprecate the field in SAC that is describing the container type – POSTCALL NOTE: The
field is actually SPM027 (HL7 item#01773)
Will pick this back up next week for voting.
Updated spreadsheet at the end of today’s call:
Page 8 of 12
2014-11-04 OM4
related vocabulary.xlsx
2014-11-11 - discussed value of 'master list' for container type; after removing copyright/service marked items, what remains is a very small list; Kathy did not
see of a user defined table since every lab will have to add their specific containers. A Coded field does offer benefits. Discussed if we could include as examples
values from the spreadsheet, without designating as a table, and suggest use of the example values; Ken thought we'd need to suggested they could not be
changed. Recapped prior actions which diminished value of table, for example, HL7 HQ advised to remove trademark, copyright items unless we had permission
from the owner. Ken asked if CLSI had a standard list of containers; Mark and Ken looked during the call but could not find. Les commented a master list usually
offers value. After discussion, the following motion was voted on:
 Motion not to create an HL7 User Defined table, leave table reference as 9999 and let trading partners decide values. Motion by Kathy Walsh, second by
Mark Jones. Vote: Against-0; Abstain-3; Affirmative-3
Freida commented since the vote was close we could vote to reopen on future call if desired.
2014-11-18 Update to Additives Spreadsheet from Kathy Walsh (discussion deferred)
Aditives220141118.x
lsx
2014-12-02: Reviewing the inserted document – there were some she had to add
AMIES liquid/Agar gel always found in combination
Have some of these in SNOMED as well in substance and product hierarchies
The table is an HL7 table - next steps?
LabMCoP can take on the review, then forward to either HL7 Vocab or HCA, whichever deals with additional vocab – steward of this table is OO – so will need to
take there 
Aditives20141203.xlsx
2014-12-16: Kathy tried to re-work the additives, but it still has trademarks and copyrights – here is the latest version
This may be more complicated for this one – we may reconsider getting permission… HL70371 is an HL7 table, with OO being the steward, any reason, why this
is an HL7 table? May be want to ask OO if this could become a user-defined table – or asking vocab – find out what the process is? In Chapter 13, under SAC-27
the value set can be extended with user-specific values.
Kathy then will go back and remove the trademarked items and bring back. Action: Freida will contact OO Co-Chairs to ask for agenda time to discuss HL70371
table.
2014-12-16 Freida emailed OO list – request to add to OO agenda January 8 call if not addressed December 18 OO call.
Page 9 of 12
RE HL7 OO
Conference Call - Webex.msg
2015-01-08 OO call – need to research Table 0371 further; table originally added in V2.4 as "Additive" Table used in SAC-27 and OM4-7. Freida to research
further (e.g. V2.8 proposals database) to determine when changed to Additive/Preservative.
Minutes 20150108
OO ConCall.docx
2015-02-03 Defer; Freida noted she added addition input on follow up research after January 8, 2015 OO call.
Research
 Changed in V2.5 when SPM-6, Specimen Additives added; table name changed and table values extended. See comparison V2.4 and V2.5 below and HL7
V2 change proposal #39, which adds values to table.
 (Hall) Recommendation – We now understand Table 0371 was initially created as an HL7 table, i.e. to require support of NCCLS codes but with caveat
the table could be extended. Since it might be problematic to revert from an HL7 to User Defined table now, recommend leaving as HL7 table and
extending in the eDOS IG to include additional values.
 Also suggest drafting letter to manufacturers to ask for permission to include their additive names in the table. Minimally, try first with one
manufacturer to gauge their response. (Freida will take action item to work with HQ).
From V2.4:
Page 10 of 12
From V2.5 –
Page 11 of 12
Chapter 13 – Note: table not renamed in Chapter 13
Chapter 8 – Note: table was renamed in Chapter 8
6. Standing agenda items: Review eDOS DSTU tracker: http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=105 It is legal to submit DSTU comments
while a document is undergoing ballot reconciliation – so Eric will post the question about when a CWE field has to match another, which components have
to match, or if all do – will then introduce to ballot recon as discovered item.
NOTE TO EDOS WORK GROUP: Please list harmonizing issues in HL7 tracker as DSTU comments to keep in sync with LOI/LRI.
7. Next Call – June 9
Call adjourned 2:58 PM EDT
Page 12 of 12
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