HL7 Immunization User Group Monthly Meeting October 10, 2019 2:00 - - PowerPoint PPT Presentation

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HL7 Immunization User Group Monthly Meeting October 10, 2019 2:00 - - PowerPoint PPT Presentation

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HL7 Immunization User Group Monthly Meeting October 10, 2019 2:00 PM ET Agenda Welcome Poll: Which perspective do you primarily identify yourself with? Updates SISC Update HL7 Workgroup Meeting Presentation Lessons

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HL7 Immunization User Group

Monthly Meeting October 10, 2019 2:00 PM ET

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Agenda

  • Welcome
  • Poll: Which perspective do you primarily identify yourself with?
  • Updates
  • SISC Update
  • HL7 Workgroup Meeting
  • Presentation
  • Lessons Learned Exploring Analysis of HL7 Log Data
  • HL7 FAQ
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SISC Update

Mary Woinarowicz

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HL7 Work Group Meeting

Nathan Bunker

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HL7 Work Group Meeting

  • Work Group Meeting
  • Meets three times a year locations

in the US and world

  • Allows work groups to meet face-

to-face to create/update standards

  • Tutorials offered concurrently
  • September meeting includes half-

day plenary presentation

  • FHIR Connectathon
  • Held two days before every WGM
  • WGM schedule
  • Jan 2019 – San Antonio TX
  • May 2019 – Montreal Canada
  • Sep 2019 – Atlanta GA
  • Feb 2020 – Sydney Australia
  • May 2020 – San Antonio TX
  • Sep 2020 – Baltimore MD
  • IIS community attends FHIR

Connectathon?

  • Jan 2021 – Henderson NV
  • May 2021 – New Orleans LA
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FHIR Connectathon

  • FHIR is the center of all HL7 activities
  • Record attendance at both the connectathon and meeting
  • Many new attendees, a lot of new energy
  • 400+ attendees at the Connectathon, divided into 40 subject tracks
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Immunization Decision Support Ballot

  • First FHIR standard from IIS community
  • Official HL7 Public Health work group project for past two years
  • Ballot #1 completed Jan 2018
  • Ballot #2 completed Sep 2019
  • Hoping to resolve ballot comments and publish by end of year
  • Interest group meets every Friday at 11 am ET
  • https://confluence.hl7.org/display/PHWG/Imm+CDS+FHIR+IG+Project+Calls
  • Join the group to help create and give input to standard
  • Motions are brought to Public Health for formal decisions
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Scenario #1: EHR queries IIS

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What is the scope of the guide?

  • In Scope
  • Communication between
  • IIS (or perhaps other health systems, such as EHR), and
  • Engine that provides evaluation and forecast for immunizations
  • To replace current proprietary web service interfaces with common standard
  • Out of Scope
  • How the results are calculated by the engine
  • How the results might be displayed to an end user
  • How the results might be used to support other IIS functions
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What is in scope for ballot #2?

  • In Scope
  • Standard childhood, adolescent and adult schedules
  • Out of Scope
  • Special conditions that impact forecast
  • Will be considered for future implementation guides
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Ballot Results

  • 46 Affirmative Votes
  • 5 Negative Votes
  • 16 Comments
  • 1 Duplicate
  • 3 Negative
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Ballot Comments

  • Consider returning a reference to the guideline used to make the

recommendation

  • Add support for risk conditions and other patient specific attributes
  • Return additional data in the operation response
  • Supporting data version
  • Version of CDS engine itself
  • Use CDS Hooks
  • Why not use CDS Hooks? Please document gaps.
  • How should we handle bad input?
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Ballot Comments

  • Add Immunization evaluation to example
  • Consider condensing two of the use cases
  • Use SNOMED instead of CVX
  • Specifying immunity
  • Recommendation given for values for Reason codes
  • Higher priority should be given to the transfer of data from non-IIS

systems

  • Not clear on what this comment means in context of this ballot
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HL7 FAQ

CDC-AIRA Technical Assistance Team

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Primary Language

  • What values should IIS accept/allow for language and how should this

affect reporting or reminder notifications?

  • HL7 perspective:
  • Optional field, no expectation that EHRs will support or populate
  • If supported, EHR should follow PHINVADS table here:
  • https://phinvads.cdc.gov/vads/ViewValueSet.action?id=43D34BBC-617F-DD11-B38D-

00188B398520

  • IIS should expect any of the languages in this set (486 values!)
  • IIS does not have to store all of these codes or use them
  • If IIS does not support or recognize the primary language
  • IIS should still process the rest of the message normally
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Primary Language

  • MIROW Reminder Recall guide
  • See page 57
  • https://repository.immregistries.org/files/resources/5835adc2dc122/mirow_reminder_r

ecall_in_iis_full_guide.pdf

  • IIS should record language
  • Reminder/Recall notifications should be in preferred language
  • Indicates a threshold for language support when a certain number of the

population speaks that language

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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
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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
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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

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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
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Lessons learned exploring advanced analysis of HL7 log data

Kevin Snow Steve Murchie Envision Technology Partners AIRA National Meeting 2019

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Disclaimer

  • While Envision is an IIS software vendor, this presentation is about

the process of discovery.

  • Analytics products discussed and/or demonstrated herein are

generally available to the public.

  • Approach presupposes availability of a variety of log data. Your

mileage may vary.

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Four years ago…

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Some technology background

  • Traditionally, large-scale data analysis has required significant

preparation of the data prior to investigation

  • Optimize performance for complex queries
  • Data warehouse or data mart most common elements
  • Helps to know what questions might be asked
  • New technologies permitting much more free-form analysis
  • “Big data” tools
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A need arises

  • Meet Kevin
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Scenario 1

  • Using Elastic to quickly answer random questions about HL7 activity

https://www.elastic.co/ Demo

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Scenario 2

  • Using Power BI to assess HL7 performance and diagnose system

issues https://powerbi.microsoft.com Demo

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Conclusions

  • Large number of options available
  • Powerful, inexpensive (at least to get started)
  • No one tool serves all needs
  • Different users, different problems
  • Logging should be first class citizen
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Backup

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  • Pros
  • Cons

What we’ve seen so far…

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More features…

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Next Meeting

November 14, 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!