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

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

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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

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HL7 Immunization User Group

Monthly Meeting May 9, 2019 2:00 PM ET

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Agenda

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

Tracy Little

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HL7 Workgroup Update

Nathan Bunker

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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
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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
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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
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SISC Guidance Document Review

Nathan Bunker

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SISC Guidance Document Review

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

  • ERR-4 Severity
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HL7 ACK Messages

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

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HL7 ACK Messages

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HL7 ACK Messages

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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
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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
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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
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HL7 RSP Guidance

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

  • Setting QAK-2
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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
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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
  • rders in 2015 and 2016
  • Manufacturers not included in request for information
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Lot Number Guidance for UoU/ UoS

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

  • Do you know of any discrepancies or have other information?
  • Share information with IISinfo@cdc.org
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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
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LOINC Codes

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

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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)
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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)
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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
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Next Meeting

June 13, 2019 2:00 pm ET / 11:00 am PT

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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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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!