HL7 Immunization User Group Monthly Meeting September 12, 2019 2:00 PM ET
Agenda Welcome Poll: Which perspective do you primarily identify yourself with? Updates SISC Update New Sub/Ack Measures for NDC National Meeting Review of HL7 sessions of interest AART Clinics HL7 Balloting Immunization CDS Profile IG HL7 FAQ
SISC Update Heather Patrick
New Sub/Ack Measures for NDC Eric Larson
2 1 3 Content Area Transport Testing & Discovery Assessment Validation Submission / Assessment Validation Testing & Discovery Acknowledgement Assessment Query / Response Testing & Discovery Validation CDS Assessment Testing & Discovery Data Quality Testing & Discovery
2 1 3 Content Area Transport Testing & Discovery Assessment Validation Submission / Assessment Validation Testing & Discovery Acknowledgement Assessment Query / Response Testing & Discovery Validation CDS Assessment Testing & Discovery Data Quality Testing & Discovery
Measures that Make Up Assessment Content Areas • 3 Measures Transport • 14 Measures Submission/ ACK • 8 Measures Query/ Response • 12 Measures CDSi • Data at Rest - #TBD Data Quality • Incoming/Ongoing Data – #TBD
Measures that Make Up Assessment Content Areas • 3 Measures Transport • 14 Measures + 2 New Measures for NDC Submission/ ACK • 8 Measures Query/ Response • 12 Measures CDSi • Data at Rest - #TBD Data Quality • Incoming/Ongoing Data – #TBD
Two New Measures 15)The IIS processes an administered vaccine using the preferred NDC format. • This will include Unit of Use and Unit of Sale test cases in the community preferred 11 digits with hyphens format 16)The IIS processes an administered vaccine using alternative NDC formats. • This will include Unit of Use and Unit of Sale test cases in known (and standard) alternative NDC formats (i.e., 10 digits w/ hyphens; 11 digits w/o hyphens)
How will this impact Validation? • It won’t change anything immediately • Validation will remain as is for now • Measures have to be in Assessment for 3 quarters before they can be considered for Validation • After 3 quarters, they can be moved to Validation through the same public comment and board approval process as Assessment • Realistically, we’d be looking at Q1 2021 to recommend moving these measures into Validation
National Meeting Nathan Bunker & Tracy Little
Interoperability Presentations • Quick review of presentations from the National Meeting • Select a few that you might have missed and want to hear • Please rate each one: • Yes, please cover this in a future HL7 User Group Meeting • Maybe • Not interested, we don’t need to cover this in future meetings
#1 Ask EHR Experts about IIS & Electronic Health Records • Author: • Danny Wise, Allscripts • Kristin Glaza, Cerner • Why tracking vaccines is important • Provider experience • Frequently misunderstood concepts
#2 Measurement & Improvement: From Transport to Decision Support, All Your Questions Answered • Authors: • Mary Beth Kurilo, AIRA • Eric Larson, AIRA • Introduction and overview to the AIRA Measurement and Improvement project • Overview of the project • Success and challenges • Frequently asked questions
#3 From Muddled to Methodized: Onboarding in Minnesota • Author: Angie Felt, MN • The steps and process that MIIC created in order to improve their onboarding • Increased the number of providers connected • Reduced their average monthly queue
#4 Colorado's Success with AIRA's Onboarding Consensus-Based Recommendations • Authors: • Darrin Rosebrook, AMCI • Kim Gulliver, CO • Showed details on improvements to onboarding process • Reduced overall project timelines
#5 Connecticut Onboarding: Starting All Over Again After a Migration • Authors: • Nancy Sharova, CT • Alejandra Arias, CT • Covered work towards re- onboarding providers to new system • New system went live Sept 2018 • Working towards onboarding goal by June 2020
#6 Bidirectional Onboarding: A Beginner's Guide to Success • Authors: • John Robinson, Philadelphia • Went over basic concepts: • Bidirectional Interface • Testing Plan • Communication • Known Issues • Problems of the Future
#7 Lessons Learned Exploring Advanced Analysis of HL7 Log Data • Authors: • Kevin Snow, Envision • Steve Murchie, Envision • Using generally available software products: • Elastic • Power BI • Get more information out of your current data • “Big Data”
#8 Improving IIS HL7 Web Service Performance in New York City • Author: • Monica Sull, NYC • Performance improvements • Redundancy • Load balancing • Database indexing • Increase threads between servers • Reduced response time • Traffic: from 3.5 to 4.0 million • Response: from 5.71s to 2.62s
#9 Something Old and Something New: Understanding HL7 Immunization Standards • Author: • Heather Patrick, CDC • Review of Frequently Asked Questions • Query/Response • HL7 Acks • Update on HL7 2.8.2 • What changed
AART Clinics • 33 AART Clinics held at the AIRA National Meeting in August • Positive feedback from attendees • Fielding many follow up questions since the AART Clinics • Reaching out to IIS teams that did not attend to schedule a virtual AART Clinic • Planning for AART Clinics at the 2020 AIRA National Meeting • What can we do to enhance the AART Clinic experience?
HL7 Balloting Immunization CDS Profile IG
Immunization Decision Support Forecast Implementation Guide STU 1 • http://build.fhir.org/ig/HL7/ImmunizationFHIRDS/index.html • Ballot #1 • January 2018 • Ballot #2 • September 2019 • FHIR release 4 • Standard for Trial Use (STU) • Votes: 46 Affirmative, 5 Negative • 4 Negatives recommended use CDS Hooks in preference to a FHIR operation
Use Case for EHR Query to IIS • Focus is on green area only • Standardizes custom web services being used today
What is next? • Ballot comments will be • Initial implementors: reviewed initially • NIST Forecast Immunization Tester • Public Health – Thursday Q1 (FITS) • Other vendors participating in the • Connectathon Sept 2019 group • Vaccine Forecast Analyzer ? • Ballot #3 • Lone Star Forecaster ? • Support added for special • Step Into CDS for Immunizations ? conditions • Integrate with Touchstone ? • Join our group and help with the • Integrate with CDS Hooks ? project!
HL7 FAQ CDC-AIRA Technical Assistance Team
Disagreement of NDC and CVX • Both CVX and NDC can be transmitted in RXA-5 • CE data type allows two representations of the same concept • One concept may be more specific (NDC is more specific than CVX) • Receiver may read one or both of the values • IIS should support both CVX and NDC • CVX support is required by the IG • NDC support is needed to support certified systems • What if the codes don’t agree? • Understanding the correct code is critical for IIS
Disagreement of NDC and CVX • Two resources that might help: • https://repository.immregistries.org/resource/iis-functional-guide/ • https://repository.immregistries.org/resource/iis-data-quality-practices-to- monitor-and-evaluate-data-at-rest/ • Ideal solution • IIS should recognize conflicts between values • IIS may return an error or warning about situation • IIS decides on what data should or should not be stored • IIS should have data quality process to engage with submitter and resolve
NIST Tool Warnings • Will generate warnings for messages • Even for NIST example messages! • Warnings indicates: • Areas that the tool cannot verify that will require additional testing to ensure conformance • Especially for RE fields • Warnings are expected: • Test messages sent by EHR systems • Production data from submitters https://hl7v2-iz-r1.5-testing.nist.gov/iztool/#/cf
Disease with Presumed Immunity & OBX-14 • When sending history of Varicella infection • OBX|1|CE|59784-9^Disease with presumed immunity ^LN|1|38907003^HISTORY OF VARICELLA INFECTION^SCT||||||F|||20090412<CR> • What do you send in OBX-14 Date/Time of Observation? • Recent SISC decision: • “If the appropriate value is not known, OBX-14 should remain empty – it is an RE field and is not required in every message instance” • But what if only YYYYMM is known? • Option 1: Send OBX-14 as blank • Option 2: Send only YYYYMM in OBX-14 • This is a conformance violation but should not prevent message from being processed
Next Meeting October 10, 2019 2:00 pm ET / 11:00 am PT
More Information • Web Links • Subscribe to immunization group http://www.hl7.org/participate/UserGroups.cfm?UserGroup=Immunization • Public User Group Wiki http://www.hl7.org/special/committees/iug/index.cfm • Private User Group Wiki http://iugwiki.hl7.org/ • HL7 Press Release http://www.hl7.org/documentcenter/public_temp_F760602A-1C23-BA17- 0C0D326E635471F9/pressreleases/HL7_PRESS_20140402.pdf • AIRA Press Release http://www.immregistries.org/events/2014/04/10/hl7-immunization-user-group
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