Orders/Observations Meeting Minutes

Winter, 1999 Working Group Meeting

Minutes of January 1999 Orders/Observations Worksession

Attendees

Attendee / Company/E-Mail / Wed AM / Wed PM / Thu AM / Thu PM / Fri AM
Susan Abernathy / saa6@ cdc.gov / x
Michael Aryev / / x / x
Nina August / / x / x / x
Rita Barsoum / / x / x / x / x
Pat Berry / / x / x / x
Bernol Blobel / / x
Melanie Buechler / / x / x / x / x / x
Don Carlson / / x / x
Stephen Dippy / / x / x / x / x / x
John Dulcey / / x / x / x
Karen Eckert / / x
Rob Eder / / x / x
Louis R. Gordon / / x / x
Rick Hahn / / x
Nancy Hall / / x / x
Darrell Hansen / / x
Susan Harada / / x
Richard Harding / / x
Catherine Haskell / / x / x / x / x / x
Peter Haug / / x
Tom Hooks / / x
Rose Jenkins / / x / x / x / x / x
Mike Jones / / x
Tim Kelly / / x / x
Austin Kreisler / / x / x / x / x / x
Joann Larson / / x
Tom Marlin / / x / x
Chip Masarie / / x
Ken McCaslikn / / x / x
Clem McDonald / / x / x / x
Dave McDowell / / x / x
Charlie Mead / / x
Mike Ostler / / x
David Pimmel / / x
Beth Porter / / x
Linda Quade / / x / x / x
Jan Root / / x
David Rowed / / x / x
Dan Russler / / x
Joyce Sager / / x
Gunther Schadow / / x / x
Helen Silucci / / x / x
Robbin Lynn Smith / / x / x
Phil Taggart / / x / x / x / x
Greg Thomas / / x / x / x
Wayne Tracy / / x / x / x
Heather von Allmen / / x / x / x
Mead Walker / / x / x / x
Deb Weiss / / x / x / x / x / x
Joyce Whitsitt / / x / x
Beverly Wilson / / x / x
Eli Wylen / / x
Robin Zimmerman / / x

Wednesday AM

Wednesday morning, the committee met jointly with Patient Administration/Financial Management to hear a proposal from Frank Oemig of Germany concerning the ordering of non-medical services. While the proposal was not approved, a task force composed of members of both technical committees was formed to review the requirements with Frank and bring this issue to resolution in time for the 2.3.2 ballot process.

The rest of the morning, Linda Quade then led the group through the changes in the RIM from the harmonization meeting. She also discussed the state transition, MIM, and MOD developed in the last meeting.

Wednesday PM

Wednesday afternoon, the committee met with Patient Care. Patient Care had reviewed the open issues list and proposed definition changes for the RIM for which O/O had stewardship. The group reviewed these change requests and approved them. Patient Care also identified discrepancies in the RIM. Volunteers agreed to go over the list and present those items to the joint committees on Thursday. The groups also agreed to coordinate their respective V3 messaging workgroups. The chairs and facilitators of the two committees will determine the logistics in a post-meeting conference call.

The committee reviewed V3 work which had been done between the last and present meeting. It identified additional work was needed. A high-level specimen state transition diagram was developed and expanded use cases for the lab order.

Three major families of use cases were defined:

  1. Order comes with sample
  2. Order come but must collect sample
  3. Sample comes unidentified sample (pat. Intended to be unknown)

Additional Use case modeling:

Manage specimen for testing

Actors:

  1. Lab
  2. Orderer
  3. Specimen collectors
  4. Source

Subcases:

  1. Specimen accompanies order
  2. Specimen collected outside order

Specimen with Order

  1. Lab receives specimen and order
  2. Specimen processed
  3. Additional test requested
  4. Get another specimen

Specimen without order

  1. Receive order
  2. Get specimen
  3. Link new order to existing specimen

State transition model for specimen. Suggested states:

Created

Drawn

Completed

Spilled

Issue what about reference labs? Are these two orders (sub order of initial order). Is this a transfer from the drawn state back to drawn state with trigger of sample transfer.

Proposed State Transitions for Specimen:

Empty  enroute

Enroute  at filler – trigger event

Drawn  spilled – trigger event

Drawn  completed

Completed  done

Completed  stored

Stored  done

Transport = at filler  at filler

It was suggested “Drawn” encompases enroute and at filler.

Thursday AM

On Thursday, Ken McCaslin of Smith Kline petitioned for O/O so sanction an implementation guide his company was developing for microbiology. He also requested volunteers from the committee to assist in this effort. He already had support from several vendors. The committee voted to endorse the effort and a conference call will be set up soon to gather volunteers and interest.

The group then returned to the V3 modeling effort further defining the domain, use cases and scope of the MIM. A state transition diagram was developed for Service event. The process/discussion is described below.

The committee determined it needed to add Service Event Relationship to MIM to support battery components.

State transition of Service Event:

The following is an analysis of the states for Service Event using result status in chapter 7 as input:

  • States are:
  • C – correction – transition - 2
  • D – deletes OBX record (ex. remove component which has not been resulted) – transition? - 1
  • F – final results - state - 1
  • I – specimen in lab; results pending – state - 1
  • P – preliminary results – state - 1
  • R – entered but not verified – state - 1
  • X - results cannot be obtained – state - 1
  • S – partial results – state - 1
  • U – result status changed to final without retransmission of results - transmission - 2
  • W – post original as wrong (ex. wrong patient) – state/tranmission - 2

Which could result be created in:

  • D – deletes OBX record (ex. remove component which has not been resulted) – transition? - 1
  • F – final results - state - 1
  • I – specimen in lab; results pending – state - 1
  • P – preliminary results – state - 1
  • R – entered but not verified – state - 1
  • X - results cannot be obtained – state – 1
  • S – partial results – state - 1

Could not be initial

  • W – post original as wrong
  • U – result status changed to final without retransmission of results - transmission - 2
  • W – post original as wrong (ex. wrong patient) – state/transmission - 2

Initial State:

o  R/unverified  F/Final  o

There a need for preliminary result as it is a super-state.

Preliminary = R/unverified  V/Verified

It is necessary to document final value as corrected because of the legal implications.

A final value is wrong when there is no replacement. A corrected value replaces the existing value and goes to the done state. The “wrong” state can exit from any state (R or F or C).

There is a need to send amendments that are not corrections, but additions of data, but this was not included in the following diagram:

o  results available  o

Within “Results available”:

unverified  any state 

Within in “any state” is:

verified  final  o

Within “final” is”

final  corrected (optional recursive)

Results available  wrong  o

o  in lab results pending  results available (any state)

specimen received

Thursday PM

The lab automation committee proposed a joint meeting with orders for the winter working group meeting. This will occur Thursday morning if administrative details with NCCLS can be resolved.

Thursday afternoon, Professor Dudeck presented a request to add specific order message types for diet, supply, nonstick and pharmacy orders. This was a request to enhance 2.3.2. For backward compatibility, the ORM message type would also be allowed. The committee voted to approve this enhancement for 2.3.2.

Patient Care joined the committee to review the changes proposed by the Wednesday night work group. All attribute realignment changes were approved. The group also approved the consolidation of Health Issue into Observation. Two new specialties of Service Intent or Order and Service Event were not approved. These would have handled Transportation Orders and Delivery, but it was decided this should be taken to Inter-Enterprise for further discussion.

Patient Care requested joint stewardship of service event, service event relationship, and clinical observation. The harmonization group has not endorsed joint stewardship in the past. Instead it was decided and approved that Orders/Observations would endorse Patient Care’s receiving stewardship of Service Event Relationship.

Friday AM

On Friday, the committee dealt with ballot votes and comments. The one negative ballot was concerned the size of the placer and filler number fields in ORC and OBR. The committee voted not to change this now. Instead additional language would be added to the definitions of these fields indicating the sizes are suggestions only and larger field sizes are valid if necessary. A thread will also be started to determine a larger size for the fields and that proposal will be presented at the spring meeting for inclusion in 2.32. The committee reviewed other 2.3.2 proposals from the Image Management SIG, Kaiser Permanente, and Australia. The committee determined all proposals needed further clarification and would be reviewed again at the spring meeting in Toronto for inclusion in 2.3.2

Agenda for Winter Working Group Meeting

Tuesday AM

Joint meeting with Patient Care: Orders/Observations and Patient Care Domain in the Rim and V3 process tutorial

Wednesday AM

V3 modeling and review of between meeting work

Wednesday PM

Joint Meeting with Patient Care: Discussion of agenda for Wednesday Evening Work Group

V3 Modeling

Thursday AM

Joint meeting with Image Management SIG

Joint Meeting with Lab Automation SIG (Tentative)

Thursday PM

Joint Meeting with Patient Care: review of recommendations from Wednesday Evening Work Group

V3 Modeling

Friday AM

2.3.2 Proposals