HL7 Immunization User Group Monthly Meeting May 9, 2019 2:00 PM - PowerPoint PPT Presentation

HL7 Immunization User Group Monthly Meeting May 9, 2019 2:00 PM ET

Agenda  Welcome  Poll: Which perspective do you primarily identify yourself with?  Updates  National Meeting Updates  HL7 Workgroup Meeting Update  Discussion  SISC Guidance Document Review

National Meeting Reminders Tracy Little

HL7 Workgroup Update Nathan Bunker

HL7 Workgroup Update • HL7 WGM and FHIR Connectathon • May 2019 – Montreal • Sep 2019 – Atlanta • Feb 2020 – Sydney • May 2020 – San Antonio • Sep 2020 – Baltimore • FHIR Dev Days • Jun 2019 - Seattle

HL7 Workgroup Update • HL7 Improvements • All new work is being done in FHIR • Older standards (HL7 v2 / HL7 v3 / CDA) are still be supported • Standards development process is being improved: • Work group documents now in confluence: https://confluence.hl7.org/ • Project Scope Statements (PSS) are now being moved online • Major push to improve Implementation Guide publishing for FHIR • Grahame Grieve is leading this effort https://onfhir.hl7.org/author/grahamegrieve/ • US government is going to fund improvements in this area • Zulip is being used for day-to-day work in FHIR and other standards • Deadlines for PSS and ballots are being lengthened

HL7 Workgroup Update • Ballot comments for CDS Immunization FHIR service • Dispositions approved by Public Health • Getting ready to publish the guide for the next ballot

SISC Guidance Document Review Nathan Bunker

SISC Guidance Document Review • Current Guidance • HL7 ACK Messages • HL7 RSP Messages • Lot Number Guidance for UoU/ UoS • LOINC Codes • Preferred/Contraindicated Vaccines

HL7 Ack Messages • https://repository.immregistries.org/resource/guidance-for-hl7- acknowledgement-messages-to-support-interoperability/ • In Scope • MSA-1 and ERR-4 • Out of Scope • Other MSA or ERR fields

HL7 ACK Messages • What does “error” or “exception” mean? Could refer to… • General concept of an error as in something unexpected, unwanted, or wrong. • Error (ERR) segment • Severity code of Error (E). • Acknowledgement Code of Application Error (AE)

HL7 ACK Messages • ERR-4 Severity

HL7 ACK Messages • IIS determines value for ERR-4 • IIS practice and policy • Jurisdiction policy and law • Data quality requirements • HL7 conformance issues

HL7 ACK Messages

HL7 ACK Messages

HL7 ACK Messages

HL7 ACK Messages • Correction and Resubmission • ACK can not indicate which parts of message were accepted • If some of the message was not accepted • Submitter should fix and resubmit all information • Receiver should merge any duplicate information

HL7 RSP Guidance • https://repository.immregistries.org/resource/guidance-for-hl7-rsp- messages-to-support-interoperability/ • In Scope • MSA-1, QAK-2, and ERR-4 • Out of Scope • Other important RSP fields • Caveats • ACK Guidance also applies, especially to values in ERR-4 • Only one ERR segment can be returned, IIS must pick salient error

HL7 RSP Guidance • Three potential outcomes of a query: • Message is rejected • query is not constructed properly, or unable to process • Error occurs in processing • unable to complete search • Query is successfully processed • with or without a match

HL7 RSP Guidance • Setting MSA-1 and ERR-4

HL7 RSP Guidance • Setting QAK-2

Lot Number Guidance for UoU/ UoS • https://repository.immregistries.org/resource/guidance-on-unit-of- sale-unit-of-use-lot-numbers/ • Two potential lot number for every vaccine: • Unit of Sale: The vaccine as sold • Unit of Use: The vaccine inside the sold container that is used • Results of 2016 query to VFC manufactures: • GSK, MedImmune, Merck, Pfizer, Protein Science, Sanofi, Seqirus • Documented patterns of lot numbers used

Lot Number Guidance for UoU/ UoS • Document has these tables; • List of all vaccines know to have different UoU/UoS lot numbers • Assume all others have matching UoU/UoS lot numbers • Estimate of the number of vaccines with different UofS/UoU based on VTrcksS orders in 2015 and 2016 • Manufacturers not included in request for information

Lot Number Guidance for UoU/ UoS • Example from the guidance:

Lot Number Guidance for UoU/ UoS • Do you know of any discrepancies or have other information? • Share information with IISinfo@cdc.org

LOINC Codes • https://repository.immregistries.org/resource/guidance-on-detailed- message-structure-and-the-use-of-specific-loinc-codes/ • In Scope • Order Segment Groups • LOINC in r1.5 • New LOINC defined since but can be messaged in a r1.5 message • Out of Scope • Local codes

LOINC Codes • Different flavors of Order Segment Groups • Immunization Event • Immunization Event (Contraindicated) • Immunization Event (Refused) • Immunization Event with Evaluation • Forecast • Patient Observations

LOINC Codes • Structure of Update (VXU) Z33 messages • Usually has at least one Immunization Event • May have Patient Observation • Order of OBX’s is not defined • Related OBX’s need to be linked by OBX-4 SubId • Not expecting • Immunization Event with Evaluation • Forecast

LOINC Codes

LOINC Codes • Structure of Complete Immunization History (RSP) Z32 • For each immunization history include one of these; • Immunization Event Order • Immunization Event with Evaluation • May include Forecast • If so, should include Immunization Event with Evaluation • Each set of vaccine forecasts has same OBX-4 SubId • All sets are put together in one Forecast (under one ORC/RXA) • May contain • Immunization Event (Refused) • Immunization Event (Contraindicated)

LOINC Codes • Structure of Complete Immunization History (RSP) Z42 • For each immunization history must be; • Immunization Event with Evaluation • May include Forecast • Each set of vaccine forecasts has same OBX-4 SubId • All sets are put together in one Forecast (under one ORC/RXA) • May contain • Immunization Event (Refused) • Immunization Event (Contraindicated)

Preferred/Contraindicated Vaccines • Current specification allows for indicating: • Vaccine group that is recommended • But some IIS want to indicate more specific guidance: • Preferred vaccine (more specific than vaccine group) • Contraindicated vaccine (specific vaccine that must not be given) • A new code will be assigned • A new OBX can then be added to forecast set • Will be permissible under current release 1.5 • Not yet finalized, waiting for LOINC from Regenstrief

Next Meeting June 13, 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

Contact Information If you have any questions or comments:  Kim Salisbury-Keith Kim.SalisburyKeith@health.ri.gov  Nathan Bunker nbunker@immregistries.org  Kevin Snow ksnow@envisiontechnology.com  Danny Wise Danny.Wise@allscripts.com Thank you!