#137 ELR Open Forum 30MAY24

Presenter/Facilitator

Topic

Question(s)/Comments

Kimberly Brown,

Brooke Beaulieu

How to handle Quest message transmission with PID-7 (DOB) is missing?

• Patient DOB is required in HL7 v2.5.1

• Occasionally, PID-7 is missing within Quest LIS. Our understanding is that there are not many of these instances as these cases tend to be on the rarer side.

• If PID-7 is missing, Quest needs guidance on how jurisdictions would like the message handled.

  • APHL can relax the validation to allow messages to pass without this field populated, but only if jurisdictions are okay with receiving without DOB.

  • Other scenario is that the message is not transmitted at all if DOB missing, as the message will not pass validation.

Resolution Options - please respond via informal poll.

1. If PID-7 missing in original message, still allow message to pass validator and transmit to PHA.

2. If PID-7 missing in original message, do NOT allow message to pass validation or be sent to PHA.

3. Other option we haven’t considered?

Nicole Stuver (Kikuchi) TN DOH-#1-In the scenario where they did not allow the message to pass validation and it was not sent to the PHA’s, would Quest’s SOP be to follow up with the client to obtain that DOB so that it can be populated and sent to PHA later? Kimberly-In the past they have made every attempt to reach the providers for anything that is missing or causing errors to go through. It would not be one SOP item because there are at least 3 or more interfaces and LIS’s in Quest as a nation. They will attempt to do everything that they can to contact but it is rather difficult to obtain a response from each provider. It would be significantly delayed

Tim Tubman-The DOB is generally something that gets called to their clients when it’s missing. They usually don’t delay testing because it is time-critical. When they’re waiting to do that, the result gets released and then eventually fails. When this happens, they are placed in the bucket to be manually re-queued once the PHC’s can obtain that DOB. There are circumstances where you can’t obtain communication from the ordering provider and then they can’t report the result.

#2-If this is a required field for an HL7 message, has there been in discussion on the client side for requirements? Tim T.-This is currently a rare event, and it is a required field (in which they will have to place something like unknown or ungiven).
Jesse Ellis (MS)-How would Quest notify the PHAs of unsuccessful attempts if they are unable to send the message? Tim T- At this point, we don’t have a process for this. We will have to develop this.

Per Brooke-An informal poll was created to gather your preference on the resolution options of the messages that can still flow with the DOB missing with the second option having more strict validation. Please review and complete the linked poll.

Riki Merrick

LOI/LRI Informational Update

• New versions of the HL7 v2.5.1 IGs for Lab Ordering (LOI) and Lab Result Reporting (LRI) have been published today – here is where you can find them and what has changed (at a high level).

• Changes for both:

  • Naming Convention for tracking the versions has changed from Release and STU releases to Edition – so both are now Edition 5

  • Updates to US Value sets for PID-10 and PID-22

  • New OIDS to reflect updated profiles

• Product brief for LOI: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=152

  • Changes include:

    • Relaxed requirements for DG1 segment in base LOI and

    • Updated OID for LOI_BWR

    • Several Updates to LOI_NDBS profile: Adjusting usage for MSH-6, PID-25, relaxed required elements in XAD datatype for PID_11 and NK1-4, updated guidance for patient name and specimen collection, updated LOINC table

    • In-scope and Out-of-scope section clarifications

    • Update to LOI_PH profile

• Product brief for LRI: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=279

  • Changes include:

    • LRI_NDBS profile: Major revision of NDBS message structure – drop of many OBRs with OBR-29 linkages to just a single OBR with the main panel code in OBR-4, updated LOINC table, removed most X usages,

    • LRI base profile: update OBX-5 use for specimen rejections

    • LRI_PH profile: Updated usages for Orc-22 and ORC-23, synchronize SPM-7 usage and value set with LOI

Per Riki-LOI and LRI has been published as of 10 days ago. The biggest change is HL7 changing their naming convention. It is no longer a release 1 STU 5 and it is now called an addition. They describe it now as an addition 5.

For LOI, there are not many changes. The changes that did occur are only to value sets.
If you have comments on the value sets, submit them on the value set publication. If you have comments on the content for the value set IG, make those comments on the value set in Jira.

On the LOI side, they relaxed the requirements for having to have a DG1 segment in the base LOI while for most commercial orders, there will be a DG1 segment (i.e. newborn screenings). They updated the LOINC table for the newborn screening profile.

For the LRI side, they made a lot of changes to the message structure. They may need to place more OBR’s back in but will be reviewing going forward. They decided to go with a single OBR with the main panel code and dropped all of the parent-child linkages.

Both IG’s have changed logs (in the back) and should be easy to review and read. They are working to get these new profile versions in GDT, but it will take some time.

Riki Merrick

Coming soon: HL7 v 2.9.1

• Not published yet, but will be in June. Once published, it will be available here: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=649

• Includes SOGI

Per Riki-2.9.1 has been validated and finalized. It is just a matter of pulling the material together (one chapter gets created out of the database) to finalize and publish. (tentative date is June)

The biggest reason for publishing 2.9.1 is for gender harmony attributes (sexual orientation, gender identity, etc.)

Brooke Beaulieu

Open Mic: Any questions or discussion topics?

• Next call 6/13 - Cancelled

  • See you at CSTE!